P-452: Erytromelalgia in pediatric type 1 diabetes mellitus: a rare presentation
M Franciulli, M Silberkasten, M E Andres, C F Rojas Montaño, J Serra, V Britto, E San MartinAbstract
Introduction
Erythromelalgia is a rare neurovascular disorder characterized by burning pain, erythema, and increased skin temperature, typically affecting the extremities. It may be primary or secondary to underlying conditions. Its association with type 1 diabetes mellitus (T1DM) is uncommon, particularly in children and adolescents. Diagnosis relies on clinical findings, and treatment is directed at symptom control and the underlying disease
Objectives
Report a case of erythromelalgia due to T1DM in an adolescent and discuss its diagnostic challenges and complex management
Methods
This is a single-patient case report. Clinical presentation, diagnostic workup, treatment interventions, and short-term outcomes were assessed. A focused literature review was performed to contextualize this uncommon association in pediatrics
Results
A 16-year-old with a 5-year history of T1DM, complicated by neuropathy, nephropathy, with suboptimal treatment adherence, presented with severe bilateral plantar burning pain refractory to outpatient treatment. Examination revealed erythema, edema, and increased temperature in both feet. Vascular, infectious, and musculoskeletal causes were excluded and electromyography confirmed sensory axonal neuropathy. Based on the characteristic clinical features and exclusion of alternative diagnoses, erythromelalgia secondary to T1DM was identified. Management was challenging and required multiple adjustments; symptom control was finally achieved with duloxetine, pregabalin, and alpha-lipoic acid, alongside non-pharmacologic measures, including hyperbaric oxygen therapy.After 8 weeks, marked clinical improvement was observed
Conclusions
Erythromelalgia is an exceptionally rare T1DM complication in pediatric patients. Diagnosis can be challenging, and management often requires an individualized, multidisciplinary approach with multiple therapeutic adjustments to achieve adequate effective symptom control