Concomitance of diabetic neuropathic amyotrophy and cachexia: a case report with review of the literature

Diabetic amyotrophy is a rare condition in which patients develop severe aching or burning pain in hips and thighs. This is followed by weakness and wasting of the muscles of proximal lower extremities, which often occur asymmetrically. Diabetic neuropathic cachexia is a different type of diabetic neuropathies. It leads to intense pain in affected extremities accompained by anorexia, weight loss as well as mood and sleep disturbances. A 42-year-old type 2 diabetic woman with a known poor glycemic control presented with loss of appetite, and weight (approximately 15 kg), severe burning sensation over her lower limbs, depression and sleep disturbances for 3 months. Symmetric wasting was noted in her proximal lower extremities with bilateral muscle weakness. Her patella and Achilles reflexes were absent with decrease in her upper extremity reflexes. We evaluated the patient as diabetic amyotrophy associated with diabetic neuropathic cachexia based on clinical signs, electrophysiological and radiological examination findings. Physicians should take into consideration these rare complications of diabetes mellitus showing characteristics different from other types of neuropathies.