My Dear Colleague,

Thank you for referring Mrs. A. DUPONT, born on 14/01/1955, considering her symptomatic association.

I will not repeat the details of Mrs. DUPONT's medical history, but she is being followed for:
- diabetes discovered in 1995 at the age of 40, initially treated with insulin therapy, then an attempt to switch to oral antidiabetic agents for 6 months in 2000 without success,
- hypercholesterolemia,
- demyelinating peripheral neuropathy,
- sensorineural hearing loss.

Family history:
- Type 1 diabetes in 2 granddaughters (children of her daughter) at ages 7 and 10, as well as in a nephew (son of her sister) at age 20.

Clinical examination:
Weight: 65 kg Height: 170 cm BMI: 22.491 kg/m²
Walking is very unstable, standing is impossible on a narrow base. There is probably apraxia, although its evaluation is complicated by profound deafness. There is no scapular winging. Distal muscle atrophy is very significant. Tactile, painful, and vibratory sensitivity is normal. There is bilateral ptosis without associated ophthalmoplegia.

The association of diabetes/hearing loss/myopathy raises the hypothesis of a mitochondrial pathology of the MIDD/MELAS type. She underwent a muscle biopsy last week to search for evidence of mitochondrial involvement in this context. I am prescribing a mitochondrial DNA study on blood and urine today.

I will see her again in consultation with these results and remain at her disposal in the meantime if necessary.

Please believe, My Dear Colleague, in the assurance of my best sentiments.