|LETTER TO EDITOR
|Year : 2017 | Volume
| Issue : 1 | Page : 67
Comments on - Wolfram syndrome: A rare mimic of Type 1 diabetes mellitus
Anubhav Chauhan, Lalit Gupta
Department of Ophthalmology, Dr. Yashwant Singh Parmar Government Medical College, Nahan, Sirmour, Himachal Pradesh, India
|Date of Web Publication||19-Dec-2016|
Department of Ophthalmology, Dr. Yashwant Singh Parmar Government Medical College, Nahan, Sirmour, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Chauhan A, Gupta L. Comments on - Wolfram syndrome: A rare mimic of Type 1 diabetes mellitus. CHRISMED J Health Res 2017;4:67
|How to cite this URL:|
Chauhan A, Gupta L. Comments on - Wolfram syndrome: A rare mimic of Type 1 diabetes mellitus. CHRISMED J Health Res [serial online] 2017 [cited 2020 Jun 1];4:67. Available from: http://www.cjhr.org/text.asp?2017/4/1/67/196075
We read with great interest the excellent article by Gutch et al. titled "Wolfram syndrome: A rare mimic of Type 1 diabetes mellitus."  We applaud the authors on diagnosing and managing the rare entity but would like to make interesting contributions.
Other abnormalities seen in Wolfram syndrome (WS) which need mention are an absent gag reflex, cold intolerance, loss of taste or smell,  and growth failure.  There are two types of WS with many overlapping features. In addition to the usual features of WS, individuals with WS Type 2 have stomach or intestinal ulcers.  Therefore, patients of WS should be subjected to gastrointestinal endoscopy. First, the diagnostic criteria for WS should be stated. Insulin-dependent diabetes mellitus with optic atrophy is sufficient criteria for the diagnosis. 
The respected authors have commented on the patients fundus that "there was no evidence of diabetic retinopathy." However, the colored fundus photograph [Figure 1] which the authors have presented in the manuscript clearly shows "multiple dot and blot hemorrhages" in both the eyes which are highly suggestive of diabetic retinopathy (unless there are other causes for such hemorrhages). Second, the red free or fundus fluorescein image [Figure 1] whichever the case may be, just below the colored fundus photograph, shows black spots or blocked fluorescence (whichever relevant), exactly corresponding to the areas of hemorrhages. This further clearly shows an underlying ischemic event in the retina probably due to diabetic retinopathy. Hence, in this regard, we beg to differ from the respected authors in regards to the comments made by them.
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Conflicts of interest
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| References|| |
Gutch M, Sahani KK, Bhattacharjee A, Kumar S, Shakya S. Wolfram syndrome: A rare mimic of Type 1 diabetes mellitus. CHRISMED J Health Res 2016;3:229-31.
Kwon BS, Han SH, Lee SA. The presence of periodic limb movement disorder in a patient with diabetes mellitus and optic atrophy (Wolfram syndrome). Sleep Med Res 2014;5:67-71.
Buryk MA, Bangalore-Krishna K, Rivera-Vega M, Garibaldi L. Wolfram syndrome: Are we aware of the severe hypoglycemic unawareness? J Diabetes Res Clin Metab 2013;2:4.
Moghtaderi M, Asadi F, Gorji M, Allahverdi B, Sayarifard F, Rostami P. A rare case of Wolfram syndrome. J Pediatr Nephrol 2015;3:35-7.
Ari S, Keklíkçí U, Caça I, Unlü K, Kayabasi H. Wolfram syndrome: Case report and review of the literature. Ann Ophthalmol (Skokie) 2007;39:53-5.