A 49 year old female presents with a non-healing ulcer on the right medial malleolus. On examination, there is symmetrical loss of sensation in both the extremities. She also complained of a recurrent white discharge from her vagina. Her menstrual cycles are irregular. She is complaining of hot flashes lately. The most likely pathological finding to be seen in the peripheral nerves is

Answer: a) Axonal neuropathy (ROBBINS 9th ED, P-1232) Diabetic foot usually presents as a chronic non-healing ulcer in the foot especially on the medial malleolus. Symmetric loss of sensation in both the lower extremities indicates the presence of diabetic neuropathy. A white discharge indicates the presence of fungal infections due to uncontrolled diabetes.DIABETIC NEUROPATHY* Diabetes is the most common cause of peripheral neuropathy.* The prevalence of this complication depends on the duration of the disease* Most common pattern - an ascending distal symmetric sensorimotor polyneuropathy* In individuals with a distal symmetric sensorimotor neuropathy, the predominant pathologic finding is an axonal neuropathy* Typically presents with sensory symptoms, like numbness, loss of pain sensation, difficulty with balance, and paresthesias or dysesthesias