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Idiopathic small fiber neuropathy: phenotype, etiologies, and the search for fabry disease.
[fabry disease]
The
etiology
of
small
fiber
neuropathy
(
SFN
)
often
remains
unclear
.
Since
SFN
may
be
the
only
symptom
of
late-onset
Fabry
disease
,
it
may
be
underdiagnosed
in
patients
with
idiopathic
polyneuropathy
.
We
aimed
to
uncover
the
etiological
causes
of
seemingly
idiopathic
SFN
by
applying
a
focused
investigatory
procedure
,
to
describe
the
clinical
phenotype
of
true
idiopathic
SFN
,
and
to
elucidate
the
possible
prevalence
of
late-onset
Fabry
disease
in
these
patients
.
Forty
-
seven
adults
younger
than
60
years
with
seemingly
idiopathic
pure
or
predominantly
small
fiber
sensory
neuropathy
underwent
a
standardized
focused
etiological
and
clinical
investigation
.
The
patients
deemed
to
have
true
idiopathic
SFN
underwent
genetic
analysis
of
the
alpha-galactosidase
A
gene
(
GLA
)
that
encodes
the
enzyme
alpha-galactosidase
A
(
Fabry
disease
)
.
The
following
etiologies
were
identified
in
12
patients
:
impaired
glucose
tolerance
(
58
.
3
%
)
,
diabetes
mellitus
(
16
.
6
%
)
,
alcohol
abuse
(
8
.
3
%
)
,
mitochondrial
disease
(
8
.
3
%
)
,
and
hereditary
neuropathy
(
8
.
3
%
)
.
Genetic
alterations
of
unknown
clinical
significance
in
GLA
were
detected
in
6
of
the
29
patients
with
true
idiopathic
SFN
,
but
this
rate
did
not
differ
significantly
from
that
in
healthy
controls
(
n
=
203
)
.
None
of
the
patients
with
genetic
alterations
in
GLA
had
significant
biochemical
abnormalities
simultaneously
in
blood
,
urine
,
and
skin
tissue
.
A
focused
investigation
may
aid
in
uncovering
further
etiological
factors
in
patients
with
seemingly
idiopathic
SFN
,
such
as
impaired
glucose
tolerance
.
However
,
idiopathic
SFN
in
young
to
middle
-aged
Swedish
patients
does
not
seem
to
be
due
to
late-onset
Fabry
disease
.
Diseases
Validation
Diseases presenting
"polyneuropathy"
symptom
erythropoietic protoporphyria
fabry disease
focal myositis
gm1 gangliosidosis
kallmann syndrome
primary hyperoxaluria type 1
systemic capillary leak syndrome
triple a syndrome
waldenström macroglobulinemia
This symptom has already been validated