Diabetic amyotrophy: too painful to explore?

<h3>Background</h3> Diabetic Amyotrophy is a rare disabling complication of diabetes mellitus. It presents as an acute or subacute, often unilateral painful neurogenic process. Early recognition and effective pain management is the mainstay of treatment. A critical question persists regarding the potential benefits of immunomodulatory treatments.¹ We present a case of bilateral sequential diabetic amyotrophy, showcasing accelerated recovery following plasma exchange compared to previous steroid treatment. <h3>Case Report</h3> A 77-year-old diabetic male presented with left leg weakness, significant pain, weight loss and recurrent falls in the preceding months. Examination demonstrated proximal left leg weakness. His HBA1c was 104 mmol/mo. CSF was unremarkable. Neurophysiology confirmed a left lumbosacral plexopathy. Given the significant pain he was commenced on pulsed steroids with a slow taper, yielding pain relief with slow improvement in power. Unfortunately, similar symptoms manifested in the right leg the following year, with confirmed right lumbosacral plexopathy on neurophysiology. He was given a trial of plasma exchange and had significant reduction in pain with an accelerated recovery, enabling independent walking five months post treatment. <h3>Conclusion</h3> Diabetic amyotrophy is often described as self-limiting condition, however, plasma exchange may rapidly improve patient outcomes, emphasising the necessity for future studies to explore the therapeutic strategies. <h3>Reference</h3> Chan YC, Lo YL, Chan ES. Immunotherapy for diabetic amyotrophy. <i>Cochrane Database Syst Rev</i>. 2017 Jul 26;<b>7</b>(7):CD006521. doi: 10.1002/14651858.CD006521.pub4. PMID: 28746752; PMCID: PMC6483238.