J Korean Diabetes.  2019 Mar;20(1):57-61. 10.4093/jkd.2019.20.1.57.

An Unusual Case of Bilateral Peripheral Edema in a Male with Undiagnosed Type 2 Diabetes Mellitus

• Baek CO
• Kim KH
• Song SK
• Kim JH

• KMID: 2442355
• DOI: http://doi.org/10.4093/jkd.2019.20.1.57

Abstract

The present article demonstrates an unusual case of bilateral lower extremity edema caused by neurogenic areflexic bladder as the first physical symptom of diabetes. A 52-year-old man presented to the emergency department because of massive edema of his lower limbs. The edema had been present for 2 weeks, was symmetrical, and was progressively covering the lower limbs up to the inguinal area, scrotal bag, and penis and was accompanied by dysuria and an interrupted urine stream. Laboratory findings revealed a serum glucose level of 657 mg/dL and glycated hemoglobin (HbA1c) level of 15.6%. Computed tomography (CT) of the abdomen and pelvis revealed marked enlargement of the bladder with bilateral hydronephrosis and hydroureter. In addition, CT demonstrated bilateral compression of the iliac veins caused by the enlarged bladder. This case highlights the importance of a broad differential diagnosis for patients with diabetes and extensive peripheral edema. Neurogenic bladder should be considered in the differential diagnosis, even in newly diagnosed diabetic patients.

Keyword

Diabetes complications; Edema; Neurogenic; Urinary bladder

MeSH Terms

Abdomen
Blood Glucose
Diabetes Complications
Diabetes Mellitus, Type 2*
Diagnosis, Differential
Dysuria
Edema*
Emergency Service, Hospital
Hemoglobin A, Glycosylated
Humans
Hydronephrosis
Iliac Vein
Lower Extremity
Male*
Middle Aged
Pelvis
Penis
Rivers
Urinary Bladder
Urinary Bladder, Neurogenic

Figure

• 

  Fig. 1 Computed tomography of abdomen and pelvis showing massive enlarged bladder (*), sagittal view (1A) with compression of both external iliac veins (arrows), axial view (1B).

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  Fig. 2 Computed tomography examination of the abdomen and pelvis after 1 month, showing normalization of the bladder and resolution of both external iliac veins (arrows).

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