Malnutrition-related diabetes mellitus in a destitute male Nigerian

Background: Malnutrition-Related Diabetes Mellitus (MRDM) formerly called “Tropical Diabetes” is a rare type of diabetes mellitus (DM), associated with long-term malnutrition. Objective: To create awareness about this rare disease in the phase of a dwindling global economy and the need for a more focused screening in vulnerable groups. Methodology: We reviewed the case records of the patient in terms of clinical presentation, imaging and laboratory parameters. Case Summary: A 19-year-old destitute male, resident in a rural-community in Nigeria, presenting with abdominal pains for 6 months, bilateral leg swelling for 5 months and lower limbs paresthesia for a month. He was diagnosed with DM a year previously, took insulin for a month, thereafter resorted to herbal remedies due to financial constraints, but later left home to beg in the streets due to hunger. Examination: Chronically-ill looking, markedly dehydrated and pale, with fluffy and pluckable hairs, peripheral oedema, multiple oral ulcers and bilateral parotid fullness. Weight was 35kg, height 1.65m and BMI was 12.9 kg/m2.Laboratory parameters: Marked glycosuria, absent ketonuria, beside random blood glucose (RBG) was unrecordably high (> 33 mmol/L), laboratory RBG was 63mmol/L, normal E/U/Cr and lipid profile, HbA1c of 13.8%, elevated alanine transaminase, low total serum proteins and albumin. Abdominal USS revealed normal-sized pancreas with diffuse echogenicity and multiple faint calculi. Plain abdominal x-rays showed multiple pancreatic calculi. A diagnosis of MRDM, fibro-calculous pancreatic (FCPD) type was made. Treatment: Insulin, antibiotics, anti-neuropathic drugs, high-calorie/high-protein diet were given, with good clinical improvement within two months. Conclusion: Regular screening for MRDM in vulnerable groups will allow early detection and treatment of affected individuals.