To describe bilateral peroneal neuropathy at fibular head associated with rapid weight loss related to Semaglutide (Ozempic).
Peroneal neuropathy or slimmer’s palsy due to weight loss is extremely rare1. When present, bariatric surgery is commonly associated with it.1 There are case reports of other rare incidence of peroneal neuropathy due to rapid weight loss after biliary surgery2, metastatic breast cancer3, anorexia nervosa4, and dietary restriction and exercise1. This is possibly a first reported case of a patient who developed bilateral foot drop after experiencing rapid weight loss with Ozempic (Semaglutide).
A 72 year old female with a history of lumbar spine laminectomies presented to the hospital after experiencing bilateral progressive foot drop over 3-4 weeks. She attended an extended yoga session (2.5 hours) following which she had mild left foot weakness which progressed over the next 2-3 weeks to bilateral, foot drop. Exam demonstrated a complete loss of dorsiflexion and eversion. Remainder of neurological examination including other muscles group strength, deep tendon reflexes were normal. NCS/EMG demonstrated demyelinating neuropathy on bilateral peroneal nerves across fibular head with some axonal loss. Other investigations such as CK, B12, TSH, iron studies, ANA screen, MRI T and L spine were unrevealing. She was treated conservatively with physical therapy but did not have a significant improvement. Eventually, she underwent surgical decompression of the left peroneal nerve.
Rapid weight loss in association with Semaglutide (Ozempic) may be associated with peroneal neuropathies at fibular head in susceptible patients.