Corticosteroid-triggered acute skeletal muscle loss in lipodystrophy: A case report

The potential liability to hypercatabolism in lipodystrophy remains to be fully elucidated. Here we report a 28-year-old Japanese woman with acquired generalized lipodystrophy, who presented with recurrence of panniculitis and anemia. After corticosteroid treatment was started, she showed rapid reductions in body weight and lean mass by 15% at maximum, accompanied by an elevated urea nitrogen/creatinine ratio, which recovered almost fully as the corticosteroid treatment was tapered and discontinued. She had multiple risk factors for hypercatabolism: lack of metabolic reserves, insulin resistance, and hyperglycemia due to lipodystrophy, lowered daily activity due to anemia, persistent inflammation, and wasting associated with panniculitis, and relatively insufficient energy and protein intake during hospitalization. More attention should be paid to the potential liability to hypercatabolism in patients with lipodystrophy, and to skeletal muscle loss as an adverse effect of corticosteroid treatment in patients at high risk, such as those with diabetes or decreased metabolic reserves. Here we report a 28-year-old Japanese woman with acquired generalized lipodystrophy, who presented with a rapid reduction in muscle mass by 15% at maximum during the weeks just after corticosteroid treatment was started. She had multiple risk factors for hypercatabolism other than administration of catabolic corticosteroid: lack of metabolic reserves, insulin resistance, hyperglycemia, lowered daily activity, persistent inflammation and wasting, and relatively insufficient energy and protein intake. More attention should be paid to the potential liability to hypercatabolism in patients with lipodystrophy, and to skeletal muscle loss as an adverse effect of corticosteroid treatment in patients at high risk, such as those with diabetes or decreased metabolic reserves. image