Abstract
A case of diabetes mellitus in a 41-yr-old man associated with the syndrome of “kwashiorkor” is described.
The patient had been treated irregularly with sulfonyl ureas for 5 years and showed gradual development of severe diabetic neuropathy including glove-and-stocking type sensory deficit in the four extremities, loss of libido and nocturnal diarrhea since about one year before admission.
On admission, he was pale and emaciated with sparse reddish hair, dry and atrophic skin, gneralized edema and ascites. His liver was 1.5 qfb enlarged with a smooth surface. The muscles of the extremities were tender and atrophic, and he was unable to walk due to muscular weakness.
Examinations revealed a malnutritional state due to malabsorptin with steatorrhea and a typical intestinal “malabsorption pattern” on X-ray films, advanced diabetes mellitus with retino-and neuropathy, and pancreatic insufficiency due to alcoholic pancreatitis with calcification.
There was familial occurrence of diabetes mellitus, and an increased response of pancreatic glucagon after arginine loadng was demonstrated. The patient's diabetic state was thus diagnosed as primary.
Administration of large doses of pancreatic enzyme preparation improved the steatorrhea. It was concluded that the malnutrition in the present case was due to a combination of diabetic gastroenteropathy and pancreatic insufficiency in view of the history and presence of advanced diabetic neuropathy.
It is noted that severe protein malnutrition tends to be very rare even in diabetics with associated chronic pancreatitis if they have no severe diabetic gastroenteropathy.
Kwashiorkor is seen mainly in children with very poor uptake of dietary protein. In adults, only few cases of “Kwashiorkor” syndrome after gasterectomy have been reported. The present case is interesting in that it shows that “Kwashiorkor” syndrome can be evoked in adults by a combination of diabetic gastroenteropathy and chronic pancreatitis.
