Insulin-induced localized lipoatrophy preceded by shingles (herpes zoster): a case report

Abstract

Introduction: Localized involutional lipoatrophy of subcutaneous adipose tissue may develop due to subcutaneous injection of pharmaceutical preparations. The pathogenesis of this adverse drug reaction is unknown. The progression of localized involutional lipoatrophy ceases and occasionally it resolves after withdrawing the inducing agent. In case of localized involutional lipoatrophy due to subcutaneous insulin therapy, low-dose systemic corticosteroids may be curative despite ongoing insulin administration.

Case presentation: We report a recurrence of insulin-induced localized involutional lipoatrophy at the abdominal wall in a 57-year-old Caucasian woman with type-1 diabetes on continuous subcutaneous insulin infusion. The first episode of insulin-induced localized involutional lipoatrophy two years previously had been cured by oral prednisone. The recurrence was treated immediately with 10mg prednisone once daily for five months, and was cured thereafter. The insulin analog preparation (Humalog™) and the insulin pump equipment (Accu-Chek Spirit™) applied were the same during both episodes. Both episodes were preceded by a temporary disturbance of the immune balance (the first episode by vaccination, the second episode through shingles).

Conclusions: This case confirms that insulin-induced localized involutional lipoatrophy in type-1 diabetes can occur again, and can be cured by systemic corticosteroids. We suggest that temporary disturbance of the immune balance may trigger this transitory idiosyncratic reaction in a susceptible individual.

Figure 1

Development of localized involutional lipoatrophy at the insulin infusion site before (15 April 2012) and during treatment with oral prednisone (10 mg/day from 15 April 2012 to 26 June 2012, 5 mg/day until 21 August 2012). No prednisone from 22 August 2012 until December 2012.

Figure 2

Development of localized involutional lipoatrophy at the insulin infusion site, before (2 December 2012) and after resumption of 10mg prednisone daily (the end of December 2012 to mid-March 2013, tapered off until 24 March 2013). No prednisone from 25 March 2013 until 31 December 2013.