Case Report: Effect of setmelanotide treatment in a young patient with acquired hypothalamic obesity following Escherichia coli sepsis and meningoencephalitis with brain abscess.

Acquired hypothalamic obesity (aHO) is a rare and severe condition caused by injury to hypothalamic centers regulating appetite, energy balance, and neuroendocrine function. It is characterized by rapid weight gain, hyperphagia, and significant metabolic complications, and current treatment options remain limited. We report the case of a 22-month-old child who developed severe acquired hypothalamic obesity following neonatal Escherichia coli sepsis complicated by meningoencephalitis and brain abscess. Treatment with the melanocortin-4 receptor agonist setmelanotide was initiated at 0.25 mg daily and gradually titrated to 1.5 mg. Over 13 months of treatment, the patient experienced stabilization and a subsequent reduction in body weight, improvement in liver enzymes and lipid profile, increased motor activity, and marked improvements in interaction and quality of life. The most pronounced clinical response occurred at doses ≥1.25 mg daily. This case represents, to our knowledge, the youngest reported patient treated with setmelanotide and the first case of inflammation-related acquired hypothalamic obesity treated with this therapy. These findings suggest that setmelanotide may represent a promising therapeutic strategy for selected patients with acquired hypothalamic obesity beyond currently approved genetic indications.