Treatment-Induced Neuropathy Presenting as Thoracic Radiculopathy and Abdominal Wall Protrusion After Marked Glycemic Improvement With Tirzepatide

Treatment-induced neuropathy of diabetes (TIND) is an uncommon acute neuropathic complication associated with marked improvement in glycemic control.It typically presents with severe neuropathic pain and may include autonomic dysfunction, although focal presentations have also been described.We report the case of a 67-year-old man with long-standing type 2 diabetes mellitus who developed severe thoracoabdominal neuropathic pain and abdominal wall protrusion following marked improvement in glycemic control after the initiation of tirzepatide.Hemoglobin A1c decreased from 11.0% to 6.6% over seven months, accompanied by a 17-pound weight loss.Several weeks after this metabolic improvement, he developed burning, stabbing, and electric shock-like thoracoabdominal pain with dysesthesia, hyperesthesia, and abdominal wall weakness.Extensive gastrointestinal, surgical, and structural evaluations were unrevealing.Electrodiagnostic testing demonstrated a generalized sensorimotor polyneuropathy, but needle electromyography of the thoracic or abdominal musculature was not performed.The clinical presentation was consistent with thoracic radiculoneuropathy occurring in the setting of marked glycemic improvement, although TIND could not be definitively established.This case highlights a focal truncal presentation temporally associated with glycemic improvement following tirzepatide therapy and emphasizes the diagnostic challenges in distinguishing TIND from spontaneous diabetic thoracic radiculoneuropathy.