Disclosures: Darshan Shah, DO: No financial relationships or conflicts of interest

Case Diagnosis: 79-year-old male with five months of severe left thigh pain and weakness

Case Description or Program Description: A vigorous elderly patient presents with acute onset of severe left anterior thigh aching, shock-like pain, and weakness impairing functional mobility. History notable for stable ulcerative colitis, well-controlled diabetes type 2 (DM2), and vague history of similar pain 4.5 years prior which resolved completely with gabapentin. Several specialties examined him and diagnosed left lumbar radiculopathy, peripheral nerve injury, greater trochanteric bursitis, and meralgia paresthetica. For each, pharmacologic, therapy services, and various injections offered no relief.

Setting: PM&R outpatient clinic

Assessment/Results: Left leg exam reveals fasciculations along femoral innervated musculature at rest, severe tenderness to light palpation, proximal weakness, sensory deficits along the L4-L5 dermatomes, and loss of patellar reflex. Ultrasound of left leg demonstrates fasciculations within deep femoral innervated musculature. The patient’s unique findings, imaging, and electrophysiologic studies are consistent with a diagnosis of diabetic amyotrophy (DA). Because of similar pain 4.5 years ago, this is likely recurrence. He completed a steroid course with moderate improvement of pain.

Discussion (relevance): To our knowledge, this is the first reported case of recurrent DA in a patient who initially completely recovered. DA is a rare condition affecting 1% of patients with DM2. Most patients partially improve, leaving lingering neuropathic pain and weakness requiring assistive devices. 6% of patients report full recovery at 2-year follow-up. This patient had complete recovery with no pain or deficits, masking the typical presentation of DA. This case resembles a rare variant, as he was asymptomatic and completely functional prior to recurrence.

Conclusions: The case emphasizes the importance of regular follow-up for completely recovered DA. Patients may have atypical clinical variations that allow them to return to fully functional life. It’s important to closely follow this population for signs of recurrence to prevent functional deficits that interfere with ADLs and mobility.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-rare-clinical-recurrence-of-diabetic-amyotrophy-a-case-report/