Diabetic Neuropathic Cachexia in a 50-Year-Old Woman with Type 2 Diabetes: First Case Report in Korea

Abstract

Diabetic neuropathic cachexia (DNC) is one of the rarest presentations of diabetic neuropathy associated with profound weight loss. A 50-year-old Korean woman with poorly controlled type 2 diabetes complained of intractable pain in the trunk and lower extremities, and total body weight loss of 17% over a 6 month period. The patient's symptoms persisted after glucose control and various medications for neuropathic pain. A diagnosis of DNC was made based on the rapid onset of severe pain, polyneuropathy, and marked weight loss without evidence of end organ disease other than mild retinopathy, and the exclusion of other possible causes. Spontaneous improvement of the patient's neuropathic pain and gradual weight gain occurred after 6 months of supportive care. Since the original report of DNC, 31 cases have been published in the English-language literature; however, ours is the first reported case in Korea. Clinicians must be aware of this debilitating complication of diabetes because of its severity and rapid progression.

Diabetic Neuropathic Cachexia: A Clinical Case and Review of Literature

“…Few cases of diabetic neuropathic cachexia have been reported so far. Using a MEDLINE search using diabetic neuropathic cachexia and acute painful neuropathy cachexia as key words, only 15 articles and 31 case reports of this DN rare variant were detected [ 1 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Table 1 summarizes the clinical aspects of cases described so far.…”

A Case Report of a Rare Debilitating Complication of Diabetes: Neuropathic Cachexia

“…The patients were noted to have spontaneous recovery in about one year [ 4 ]. So far over the years, less than 50 cases have been reported, and DNC has been found to be typically seen in middle-aged males, who are recently diagnosed with type 2 diabetes mellitus [ 5 ]. It is also known to occur irrespective of the duration of their diabetes, or type of diabetes (also seen in type 1 diabetes patients), in females, and in pediatric patients [ 6 ].…”

“…The other characteristic feature of DNC is rapid, unintentional weight loss, the mechanism of which is so far unclear. Some reports attribute this weight loss to hyperglycemia leading to glycosuria or massive pain depression leading to anorexia [ 5 ]. The overall weight loss could reach up to 60% of total pre-neuropathic-onset body weight [ 4 ].…”

“…While a majority of patients with DNC experience a single episode and recover fully, some recurrent cases also have been reported [ 9 ]. A comprehensive list of differential diagnoses including malabsorption syndromes, malignancies, connective tissue diseases (CTD), neuropathic carcinomatosis, toxic or alcoholic neuropathy, porphyria, and chronic relapsing Guillain-Barré syndrome must be ruled out before confirming the diagnosis of DNC [ 5 , 7 ].…”