Chorea is an infrequent expression of nonketotic hyperglycaemia. This is a distinctive case that shows the need to be aware of nonketotic hyperglycaemia as a cause of chorea in a 72year old Asian female patient with poor glycaemic control. The patient was a known case of type 2 diabetes mellitus and was not on regular medication for diabetes mellitus. She had an acute onset of involuntary movements on both limbs. Laboratory test showed random blood sugar was very high (1013mg/dl), ESR was elevated (72mm/hr), urine sugar (4+) and urine ketone negative. Computerized tomography brain showed age related atropic changes and no evidence of focal space occupying lesion or intracranial haemorrhage. She was started on insulin therapy, movements reduced, however involuntary movement reappeared, so anti – chorea medications were added to the treatment. Patient became better, her glycaemic state gradually decreased and the involuntary movements was also improved and got discharged.
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