Facial sweating & multipl...

A 38-year-old woman with chronic renal failure caused by diabetic nephropathy presented with an 8-month history of gradually progressive bilateral facial sweating. It occurred whenever she ate but was more pronounced during the eating of warm meals. Perspiration was first felt and became visible after 10-20s on the forehead and extended to the base of her neck. To the patient’s embarrassment, often streams of sweat ran down her face. It persisted for about 5 min after eating. Since the age 2, the patient was known for brittle type I DM. She underwent pancreatic transplantation at the age of 30, which was lost by chronic rejection and removed 1 year later. For approximately 10 years, she was known to have diabetic nephropathy, which finally progressed to chronic renal failure complicated by proliferative diabetic retinopathy & neuropathy. She also suffered from multiple transient ischemic attacks. EMG showed a symmetrical demyelinating neuropathy. During the facial sweating, no hypoglycaemia was observed. The distribution of sweating was examined by application of an iodine and starch combination to the skin, resulting in a blue-black discolouration whenever sweating occurs.