Rapid weight loss and pain in the foot

A 52‐year‐old man was referred with a 15kg weight loss over eight weeks associated with loss of appetite, nausea and early satiety. The day before admission he developed numbness and pins and needles in his left foot. He had hypertension and diabetes which was diagnosed three years previously. His control was very good with latest HbA1c of 6.6% (49mmol/mol) on metformin only. He had no evidence of microvascular complications. He had extensive investigations which included CT head, thorax, abdomen and pelvis, tumour markers, prostatic specific antigen, autoantibody screen and protein electrophoresis, which were all normal. Nerve conduction studies and electromyography confirmed right ulnar neuropathy and showed non‐specific neuropathy in the lower limbs. A diagnosis of diabetic neuropathic cachexia was made. It is important for this condition to be recognised and considered in patients with diabetes mellitus in order to avoid unnecessary and lengthy investigations. Copyright © 2011 John Wiley & Sons.