Ahmed M Yassin1, Sheetal Shroff2, Shreshta D Patel1, Asif M Paker3, Megan A Berman1, George R Jackson4. 1. The University of Texas Medical Branch, Galveston, TX, United States. 2. The University of Texas Medical Branch, Galveston, TX, United States. Electronic address: shshroff@utmb.edu. 3. Massachusetts General Hospital, Boston, MA, United States. 4. Baylor College of Medicine, Houston, TX, United States.
Abstract
BACKGROUND: Chorea is a common presenting feature of metabolic disorders, including nonketotic hyperglycemia in patients with type 2 diabetes mellitus, but rarely has been reported in diabetic ketoacidosis, hypothyroidism and vitamin B12 deficiency. METHODS: Review the literature for reported cases of chorea as a presenting manifestation in metabolic disorders. RESULTS: We report a case of hemichorea in a patient with type 2 diabetes mellitus complicated by diabetic ketoacidosis. The patient had a two day history of right sided hemichorea and decreased level of consciousness. Initial laboratory studies revealed hyperglycemia, ketosis and an anion gap metabolic acidosis consistent with diabetic ketoacidosis. Once treatment was started the choreiform movements significantly improved over three weeks. CONCLUSION: Although DKA has been rarely reported as a trigger for chorea, it should be in the differential diagnosis of a patient presenting with an acute chorea. Given the reversible nature of this disease, early recognition and treatment are imperative.
BACKGROUND:Chorea is a common presenting feature of metabolic disorders, including nonketotic hyperglycemia in patients with type 2 diabetes mellitus, but rarely has been reported in diabetic ketoacidosis, hypothyroidism and vitamin B12 deficiency. METHODS: Review the literature for reported cases of chorea as a presenting manifestation in metabolic disorders. RESULTS: We report a case of hemichorea in a patient with type 2 diabetes mellitus complicated by diabetic ketoacidosis. The patient had a two day history of right sided hemichorea and decreased level of consciousness. Initial laboratory studies revealed hyperglycemia, ketosis and an anion gap metabolic acidosis consistent with diabetic ketoacidosis. Once treatment was started the choreiform movements significantly improved over three weeks. CONCLUSION: Although DKA has been rarely reported as a trigger for chorea, it should be in the differential diagnosis of a patient presenting with an acute chorea. Given the reversible nature of this disease, early recognition and treatment are imperative.
Authors: Joana Silva Marques; Nuno Monteiro; Ana Nunes; João Machado; João Olivério; Ana Sofia Martins; António Correia Journal: Eur J Case Rep Intern Med Date: 2018-04-24