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

Abstract

IntroductionLocalized 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 presentationWe 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).ConclusionsThis 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.

Lipoatrophy Associated With Maxillary Bone Graft for the Purpose of Dental Implants and Correction by Fat Grafting: A Case Report

“…Localized after injection of the following substances has been reported in the litterature: has been reported in the literature: corticosteroids, 1,2,28 -37 insulin, 38 -43 antibiotics, 44 -46 methotrexate, 47 recombinant growth hormone, 48 soft tissue fillers, 49 glatiramer acetate, 50 -52 diphtheria–pertussis–tetanus vaccine 53 measles–mumps–rubella vaccine, 54 and influenza vaccine. 55 Most of them are associated with the involutional subtype that is characterized by a decrease in fat lobules containing small adipocytes.…”

Detemir plus aspart and glulisine induced lipoatrophy: 2015 literature review and report of a new case

“…There are also case reports of adding glucocorticoid therapy such as dexamethasone or betamethasone to the insulin analog [ 20 , 45 ]; but this can cause blood glucose fluctuations if the betamethasone/insulin analog solution becomes inhomogenous resulting in erratic insulin administration [ 20 ]. Administering low-dose oral glucocorticoid such as prednisone 5–10 mg daily [ 46 , 47 ] has also been used to improve lipoatrophy. Corticosteroids are able to induce differentiation of adipocytes and have immune-modulating properties [ 45 ].…”

Multifocal lipoatrophy secondary to insulin injection in a patient with type 2 diabetes, hepatitis B virus infection, and liver cirrhosis

“…Insulin-induced lipoatrophy is a rare complication of repeated insulin injection that manifests as a reduction in local subcutaneous adipose tissue mass. [1][2][3] Many factors are involved in the etiology of lipoatrophy, including adverse immunological sideeffects of insulin therapy and anaphylaxis connected with impurities in the preparations. 4,5 With the development of high-purity insulin and its analogs, insulininduced lipoatrophy has become less common and multifocal lipoatrophy is even rarer.…”