2021 Volume 64 Issue 12 Pages 586-591
A woman had been diagnosed with type 2 diabetes mellitus at 11 years old. Despite initiating treatment, she frequently suspended outpatient visits and finally discontinued treatment at 26 years old. She remained asymptomatic until developing involuntary movement in her left upper limb at 29 years old. She was hospitalized 12 days after the onset. Her glucose level was 603 mg/dL, and HbA1c was 16.1 % at that time. She was clinically diagnosed with diabetic chorea, although magnetic resonance imaging revealed no abnormalities of either the putamen or the striatum on T1-weighted imaging. The movements resolved the next day after insulin therapy, while glucose levels often dropped below 70 mg/dL during hospitalization. Five days after discharge, she experienced eye pain, visual field impairment, and right eyelid ptosis. She was re-hospitalized and diagnosed with diabetic ophthalmoplegia. Her clinical features appeared to be attributable to long-term untreated hyperglycemia and microthrombus formation caused by decreased glucose levels, underlying simultaneous development of both rare diseases despite her youth, which are commonly developed in the elderly. In addition, severe microangiopathy, such as proliferative diabetic retinopathy and nephrotic syndrome, was likely to have accompanied the focal ischemic changes, leading to the development of diabetic chorea and ophthalmoplegia.
