This 40-year-old patient presented with a one-year history of slowly progressive painful burning sensation involving both feet. Electrodiagnostic studies (NCS) were normal (i.e. negative for evidence of large fiber neuropathy). Skin biopsies from the ankle, knee and thigh were performed to evaluate for possible small fiber neuropathy.
What abnormality is seen in the Figure #1 from a PGP9.5 immunostained tissue section?
A. Beaded fibers
B. Melanocyte staining
C. Subepidermal plexus
D. No abnormality
What abnormality is seen in Figure #1 from a PGP9.5 immunostained tissue section?
A. Beaded fibers <– correct answer
The intraepidermal nerve fibers have an abnormal beaded appearance. This is felt to reflect the presence of nerve fiber injury, and is similar to axonal spheroids seen in the brain due to axonal injury with associated impairment of axonal transport and patchy accumulation of neurofilament (colloquially designated a “constipated axon”).
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