title: Insulin-induced localized lipoatrophy preceded by shingles (herpes zoster): a case report.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
authors: Practice of Endocrinology and Diabetology, PD Dr, Kimmerle, Aachener Strasse 196, 40223 Düsseldorf, Germany. chantelau@gmx.de.
authors: Ernst A
authors: EA
authors: Chantelau
authors: Ruth
authors: R
authors: Prätor
authors: Jörg
authors: J
authors: Prätor
mesh_terms: D001284:Atrophy; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006562:Herpes Zoster / Q000150:complications* / Q000276:immunology; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D055104:Infusions, Subcutaneous; D007328:Insulin / Q000009:adverse effects*; D007332:Insulin Infusion Systems; D008060:Lipodystrophy / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D050507:Subcutaneous Fat, Abdominal / Q000473:pathology*
chemical_list: D005938:Glucocorticoids; D007004:Hypoglycemic Agents; D007328:Insulin; D011241:Prednisone