Dados do Trabalho

Título

Acute painful diabetic neuropathy: presentation of a treatment-induced case

RESUMO

Case report: Female, 19 years old, presented in October 2021 to the neurology service with a picture of burning pain in the lower limbs. History of DM1, diagnosed when he developed diabetic ketoacidosis in 2018; Treated with insulin and oriented on the management of the disease. Follow-up was irregular in the first two years, with no attendance at follow-up appointments. Readmitted to the endocrinology department in March 2021; She weighed 70kg and had an HbA1C index of 15.6%. She was oriented and showed no changes in the level of consciousness. Returns in September 2021, with 55kg, after strict metabolic control. HbA1C of 6.9%, with intense pain, characterized by numbness and a burning sensation involving bilateral feet. Her thyroid profile was within normal limits, as was vitamin B12. She was medicated with 60mg/day of morphine and referred to the neurology department for investigation. A nerve conduction study suggested bilateral axonal predominant sensory polyneuropathy of the lower limbs. Upper limb nerve conduction studies were normal. The cause of the neuropathy was diagnosed as treatment-induced neuropathy (TIN). Treatment was started with opioid dose reduction and gradual introduction of amitriptyline and gabapentin. In the control consultations, he showed good evolution, despite gradually lower doses of medication. Discussion: Acute painful diabetic neuropathy (APDN) is rare and seen in both type 1 and type 2. The incidence of APDN is not known and is probably less than 1 in 1,000 diabetic patients. APDN can manifest as treatment-induced neuropathy (TIN) and diabetic neuropathic cachexia (DNC). Studies have shown that it can occur after rapid glycemic control with insulin, as in the case presented here, and in patients using oral antidiabetic drugs. A set of diagnostic criteria for TIN is proposed, including: (1) acute onset of neuropathic pain or autonomic symptoms, (2) a decrease in HbA1c level of more than 2% at 3 months, and (3) onset of neuropathic pain and /or autonomic symptoms within 8 weeks after the decrease in HbA1c level. Pharmacological treatment should be performed in conjunction with the holistic management of the patient. Final Comments: Physicians' awareness of this rare and completely reversible condition is necessary to ensure proper treatment and adherence to glycemic control.

Palavras Chave

Acute painful; diabetic neuropathy; treatment-induced.