Diabetic Amyotrophy Associated With Hepatic Virus C Infection

Abstract

The objective of this study was to present a case of diabetic amyotrophy (DA) associated with hepatitis C virus (HCV), and to discuss the diagnosis, treatment, possible pathogenesis, and risk factors of this rare form of diabetic neuropathy. We performed a detailed case report, and review of the literature combined with clinical observation. The clinical features, electrophysiological findings, and treatment of DA are outlined. The differential diagnosis and key features of each individual disease process within the differential are delineated to rule out other neuropathies. Pathogenic theories and risk factors for the development of DA, including the hypothesis of reactivation of dormant HCV leading to an immune response which further damaged the nerves and caused the systemic features of DA, are discussed. The diagnosis of DA is based on clinical findings and exclusion of other disease processes that can result in similar findings. DA is a rare complication associated with diabetes, which is more likely to occur with an excess alcohol intake. Furthermore, in this case, we speculate that the presence of HCV infection could have a role in the pathogenesis of DA. (The Endocrinologist 2003;13: 445-448) CASE REPORTSA 57-year-old black man with a 30-year history of diabetes mellitus complicated by background retinopathy presented to our diabetes clinic for evaluation and treatment. His latest A1c was 6.3% without hypoglycemic episodes, and his preprandial home glucose monitoring readings ranged between l40 and 180 mg/dL. His current therapy consisted of 70/30 insulin twice daily; however, he did not comply with a diabetic diet or an exercise program.His chief complaints were pain, numbness, and weakness in his thighs, which had progressed over the past year. Over the same timeframe, he had sustained a 40-pound weight loss without any change in appetite or bowel pattern. He also reported a slow onset of depressive symptoms and systematic inquiry revealed longstanding impotence (Ͼ5 years). His leg weakness had progressed, requiring him to use a cane to ambulate and his arms to rise from a seated position. A recent workup by his physician was unremarkable but did reveal mild dyslipidemia and moderate elevation of liver enzymes.In addition to insulin, his medications were nisoldipine, omeprazole, and a multivitamin. His medical history was remarkable for an esophageal stricture, which had required dilatation, an appendectomy, and hypertension. He smoked a pack of cigarettes and consumed a pint of vodka everyday. His family history was significant only for his father and sister having type 2 diabetes.On physical examination, vital signs revealed a pulse of 122 beats/min, which did not change with standing or a Valsalva's maneuver; a blood pressure of 120/74 mm Hg, without orthostatic change; a respiratory rate of l6 breaths/ min; and a temperature of 98.2°F. He was 68 inches tall and weighed 122 pounds (body mass index, 18.0 kg/m 2 ). He was thin but not cachetic, alert, and in no distress. A new finding on physical e...