Bellelli Alessio, Santi Daniele, Simoni Manuela, Greco Carla
Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 42121 Modena, Italy.
Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, 41125 Modena, Italy.
Life (Basel). 2022 May 4;12(5):680. doi: 10.3390/life12050680.
A 46-year-old man was admitted to the surgical department because of abdominal pain and anemia, with the radiological finding of a perforated duodenal ulcer, and underwent laparoscopic surgical treatment. Type 2 diabetes mellitus (T2DM) had been diagnosed 5 years earlier and treated with diet. At clinical investigation, the patient was depressed and anorexic; moreover, he complained of lower extremity weakness and bilateral feet pain, burning in nature and accompanied by allodynia. This painful sensation had been preceded by an 8-month history of fatigue and anorexia with profound weight loss of 35 kg. After clinical evaluation and a nerve conduction study, diagnosis of diabetic cachectic neuropathy was made based on the rapid onset of severe neuropathic pain in the context of diabetic neuropathy, marked weight loss, and depressed mood. The therapy with pregabalin and duloxetine had scarce effect and was gradually discontinued. The patient, however, obtained progressive relief and amelioration of neuropathic lower-limb pain concomitant with weight gain. This clinical trend also confirmed the diagnosis of this rare form of diabetic neuropathy. A few cases of diabetic neuropathic cachexia have been reported in the literature and are briefly reviewed here.
一名46岁男性因腹痛和贫血入住外科，影像学检查发现十二指肠溃疡穿孔，接受了腹腔镜手术治疗。2型糖尿病（T2DM）于5年前确诊，一直通过饮食控制。临床检查时，患者情绪低落、食欲不振；此外，他还抱怨下肢无力和双脚疼痛，呈烧灼样，并伴有痛觉过敏。这种疼痛症状出现前有8个月的疲劳和厌食史，体重显著减轻35千克。经过临床评估和神经传导研究，基于糖尿病神经病变背景下严重神经病理性疼痛的快速发作、显著体重减轻和情绪低落，诊断为糖尿病恶病质神经病。普瑞巴林和度洛西汀治疗效果不佳，逐渐停药。然而，患者体重增加的同时，下肢神经病理性疼痛逐渐缓解并改善。这一临床趋势也证实了这种罕见的糖尿病神经病变的诊断。文献中报道过几例糖尿病神经病变恶病质病例，在此简要回顾。
