Disclosures: Hannah Farmer, DO: No financial relationships or conflicts of interest

Case Diagnosis: Pediatric Diabetic Amyotrophy

Case Description or Program Description: An 11-year-old previously healthy and functionally independent female who presented with diabetic ketoacidosis due to new onset type 1 diabetes mellitus with hemoglobin A1c of 11.2% developed unilateral left hip and knee weakness with associated lower leg numbness and tingling. Physical exam 2 weeks after initial presentation revealed 2/5 strength at left hip flexors and knee extensors with reduced sensation to light touch and allodynia of the left lower extremity. The patient required a hinged-knee brace locked in extension with a front-wheeled walker for ambulation at the time of discharge home 4 weeks after initial presentation.

Setting: Tertiary care pediatric hospital, academic-affiliated free-standing inpatient rehabilitation facility, academic pediatric physical medicine and rehabilitation clinic

Assessment/Results: Electromyography (EMG) and nerve conduction study performed 5 weeks after initial presentation revealed an incomplete left femoral neuropathy versus upper lumbosacral plexopathy suggestive of diabetic amyotrophy. Magnetic resonance imaging (MRI) of the pelvis obtained 10 weeks after initial presentation revealed abnormal signal along the course of the femoral nerve and subacute denervation changes of the left vastus medialis, vastus intermedius, vastus lateralis, and sartorius muscles with sparing of the pectineus and rectus femoris muscles. Hemoglobin A1c was 5.7% after 8 weeks. At 13 weeks, strength improved to 4/5 at left hip and knee, and the patient was able to ambulate independently while using a single crutch for longer distances.

Discussion (relevance): The patient’s physical exam, EMG, and MRI findings were determined to be due to diabetic amyotrophy. Diabetic amyotrophy is well described in adults with new onset or poorly controlled diabetes; however, this disorder has rarely been documented in pediatric patients. As the patient’s hyperglycemia improved, function improved with physical therapy, which is consistent with adult diabetic amyotrophy.

Conclusions: Diabetic amyotrophy should be considered in pediatric patients who have unilateral proximal weakness, thigh numbness, and poorly controlled diabetes.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/pediatric-diabetic-amyotrophy-a-case-report/