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

I have been plagued w/ recurring shingles, twice in last 6 months. Shingles is caused by the same virus as chickenpox (varicella zoster). Dermatologists – doctors who specialize in the health, diagnosis and treatment of skin and its conditions. Cerebral arteries obtained from 4 subjects with diabetes less than 24 hours after they died were analyzed. Before a vaccine was developed in 1994, chickenpox was a common contagious childhood disease that produced itchy blisters, but rarely caused serious problems. The shingles rash usually affects a single dermatome in a unilateral band-like pattern and sometimes extends past the midline (Figure 1). It can put teens at risk of a rare but serious illness called Reye syndrome.

It is only on one side and often it affects the nerves to the chest, tummy, leg or face. These are the areas where the rash will eventually develop. In-person interviews are conducted throughout the year in a probability sample of households, and NHIS data are compiled and released annually. The severity and duration of an attack of shingles can be significantly reduced by immediate treatment with antiviral drugs, which include acyclovir, valacyclovir, or famcyclovir. Localized involutional lipoatrophy (LIL) of subcutaneous adipose tissue is a rare condition, characterized by reduction of fat cells in size, and, occasionally, in number. If the virus is detected, treatment can help prevent or weaken the severity of the illness. Some of the most common side effects of LYRICA are dizziness, blurry vision, weight gain, sleepiness, trouble concentrating, swelling of your hands and feet, dry mouth, and feeling “high.” If you have diabetes, tell your doctor about any skin sores.

A history of anaphylactic or anaphylactoid reactions to gelatin, neomycin, or other components of the vaccine Acquired or primary immune deficiency states, including AIDS Cancer chemotherapy or radiotherapy Leukemia Lymphoma Organ transplantation Active untreated tuberculosis Pregnancy or breast-feeding. We look forward to helping you make your trip a healthy and safe one. This may have an impact on overall health, feelings of depression, and the immune system. The pain may be severe in the area where the blisters were present. • However, if you have shingles blisters, the virus in the fluid can infect someone who has not had chickenpox and they may develop chickenpox. Other medicines used to treat shingles include antihistamines, pain medicines, and certain creams containing capsaicin to reduce pain. Quantitative polymerase chain reaction revealed a reduction in adipocyte-specific messenger ribonucleic acid (mRNA) (perilipin, adiponectin, fatty acid-binding protein 4, peroxisome proliferator-activated receptor gamma 2), whereas mRNA of adipocyte enhancer-binding protein 1 was enhanced, and of leptin was reduced to zero [6].

Do not stop taking LYRICA without talking to your doctor. Rather, the histopathologic pattern was like that of fat tissue undergoing starvation, except for the amyloid deposition, that is conglomerates of denaturated exogenous insulin or insulin analog [7]. 5. People with lesions on the torso may feel spasms of pain at the gentlest touch. Take care to keep your skin clean and avoid exposure to germs. In children, insulin-induced LIL may resolve spontaneously after changing the insulin brand [8]. We have recently reported on a patient with incipient LIL induced by external insulin pump therapy with Humalog™ [5].

Within 10 months of low-dose oral prednisone treatment, the LIL resolved completely. We now report another episode of LIL in the same patient, at an insulin infusion site close to a previously lipoatrophic area. Some doctors report that patients occasionally benefit from alternative treatments for pain, such as acupuncture and electrical stimulation of nerve endings. At the time of writing this report, in March 2014, she is still free from significant diabetic retinopathy, nephropathy, and neuropathy. She has been treated with an insulin pump since 1984, and has been using a U-100 analog insulin lispro (Humalog™, Eli Lilly Deutschland, Bad Homburg, Germany) since 2004. The equipment applied from 2008 onward comprised an Accu-Chek Spirit™ insulin pump and Accu-Chek FlexLink™ infusion sets with 8mm steel cannula (all from Roche Diabetes Care, Burgdorf, Switzerland). The cannula part of the infusion set was changed every two days, and the tubing (60cm long) was changed every 10 days, together with the insulin reservoir inside the pump.

The dose of Humalog™ was around 25 to 30 units/day. Apart from Humalog™, her current medication consists of levothyroxine 125μg once daily because of immunogenic thyroid atrophy. Her most recent glycated hemoglobin (HbA1c) test result (normal range 4 to 6 percent of total hemoglobin) was 6.3 percent, and her body mass index was 23 to 24kg/m2. Following a hepatitis vaccination with Twinrix™ (GlaxoSmithKline Dresden, Germany), in 2007 and 2008, our patient had experienced a first episode of LIL at the Humalog™ infusion sites on both sides of the umbilicus. STDs such as genital warts (HPV) , syphilis. After a prolonged cold between December 2011 and January 2012, herpes zoster (shingles) broke out at the left thoracolumbar region (T 10 dermatome), and healed uneventfully in February 2012. Shortly thereafter, in March 2012, a solitary spot of subcutaneous fat atrophy was noticed at one catheter insertion site on the abdominal wall left of the umbilicus (Figure ), and was diagnosed as LIL recurrence.

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). The trauma induced by the wound and its subsequent necrotizing fasciitis may have provided an adequate degree of stress to provoke the development of HZ and its associated PHN.

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