Diabetic Neuropathic Cachexia in a Young Woman

Abstract

Profound weight loss with painful symmetrical peripheral neuropathy in diabetic patients was first described as di-abetic neuropathic cachexia more than 4 decades ago. It is a distinct type of diabetic peripheral neuropathy that oc-curs in the absence of other microvascular and autonomic complications of diabetes. The mechanism and precipi-tating cause are unknown. It was reported to have good prognosis with spontaneous recovery within months to 2 years. However, it was frequently missed by clinicians because the profound weight loss is the most outstanding complaint, rather than the pain, numbness, or weakness. This often leads to extensive investigation to exclude more sinister causes of weight loss, particularly malignancy. We report a case of a young woman with well-con-trolled diabetes who presented with profound unintentional weight loss (26 kg), symmetrical debilitating thigh pain, and clinical signs of peripheral neuropathy. As the disease entity may mimic an inflammatory demyelinating cause of neuropathy, she was treated with a trial of intravenous immunoglobulin, which failed to give any signifi-cant benefit. However, she recovered after 6 months without any specific treatment, other than an antidepressant for the neuropathic pain and ongoing rehabilitation.