To describe a rare complication associated with diabetic lumbosacral radiculoplexus neuropathy (DLRPN).

DLRPN is an immune-mediated neuropathy characterized by pain followed by weakness and paresthesias in the lower limbs, sometimes involving the upper limb or thoracic nerve roots. Respiratory involvement is rare and has been reported in the setting of phrenic neuropathy, however, to our knowledge, this is the first report of DLRPN presenting with clinically significant dyspnea and neuromuscular respiratory weakness in the setting of multilevel thoracic radiculopathies.

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A 61-year-old male was diagnosed with type 2 diabetes and four months after starting treatment, developed subacute, progressive, painful right and subsequent left leg weakness and paresthesias with orthostatic hypotension. His hemoglobin A1C dropped from >14% to 6.1% over 6 months with 100lb weight loss. He then developed severe dyspnea with a band-like sensation and numbness around his abdomen. Spinal and chest imaging were unremarkable. Lumbar puncture revealed elevated protein of 92.2mg/dL. He was treated with 12 weeks of weekly 1g intravenous methylprednisolone resulting in improvement of his pain and weakness, but the dyspnea persisted. Pulmonary function testing showed reduced forced vital capacity of 30.9mL/kg, mean inspiratory pressure of -49.4cmH₂O, and expiratory pressure of 39cmH₂O, raising concern for motor neuron disease and resulting in referral to our center. On examination, he had asymmetric distal greater than proximal lower extremity weakness, mild length dependent sensory deficits, and brisk reflexes. Right-sided EMG confirmed the presence of a lumbosacral radiculoplexus neuropathy as well as multilevel thoracic radiculopathies (T4-T11) with active denervation. Needle EMG and ultrasound of the diaphragm were normal with normal phrenic nerve conductions.

This case expands the clinical spectrum of DLRPN to include multilevel bilateral thoracic radiculopathies causing neuromuscular respiratory weakness.