Prior to publication all authors have given signed confirmation of agreement to article publication and compliance with all applicable ethical and legal requirements, including the accuracy of author and contributor information, disclosure of competing interests and funding sources, compliance with ethical requirements relating to human and animal study participants, and compliance with any copyright requirements of third parties. == REFERENCES ==. A female in her 20s with a past medical history of asthma, DM1, and postpartum depression presented to the emergency department because of difficulty ambulating associated with lower extremity weakness and worsening leg pain. The lower extremity weakness, mainly in BI-9627 the left leg, was associated with difficulty in walking, which began a month prior. The pain was only in the left leg, which started in her left lateral thigh and radiated down to left foot. It was very severe (10/10), described as muscle cramp-like in nature, and had progressively gotten worse over the course of five days prior to presentation. She also stated that the left foot was swollen previously, which was not related to trauma. These symptoms were preceded by newly diagnosed DM1 with diabetic ketoacidosis and profound unintentional IFNA17 weight loss. Her family history was positive for rheumatoid arthritis. On review of her symptoms, the patient admitted blurry vision, occasional headaches, and occasional back pain. She denied any loss of sensation or tingling in her extremities, change in bladder or bowel habits, dizziness or falls, or any recent infection. She had been in her usual state of good health until a month after delivery. Upon physical examination, vital signs were within normal range, except for a heart rate of 93, presumably due to pain. The patient weighed 46 kg with a BMI of 16.9. There was tenderness on palpation of the left ankle and foot. On neurological examination, cranial nerves 212 were grossly intact, deep tendon reflexes were 2+ bilaterally in the upper and lower extremities, and the strength in BI-9627 the left and right lower extremities were noted as 3/5 and 5/5, respectively. The rest of her physical examination was noncontributory. Laboratory findings were pertinent for hemoglobin of 10.9 gm/dL, mildly elevated chloride level of 110 mmol/L, and asymptomatic urinary tract BI-9627 colonization. A lower extremity venous Doppler study was negative for deep vein thrombosis. A lumbrosacral CT imaging study showed mild to moderate curvature of the lumbar spine with no evidence of neural compromise. X-ray imaging study of the left foot was negative for fractures and found moderate hallux valgus. She received oxycodone/acetaminophen for pain and alprazolam for anxiety. A couple of days later, the patient continued to have difficulty ambulating, even with the assistance of a roller walker. In addition, the patient exhibited dragging of her left foot when ambulating. She also complained of a numbness and tingling sensation in the toes of her left foot. MRI studies of the head and spine were negative for pathologies, and the X-ray imaging of the hips were also negative for fractures/acute phase of avascular necrosis. About a week into admission, she developed several episodes of diaphoresis and sinus tachycardia with a heart rate in the 200220 bpm range. Electrocardiogram (EKG) revealed sinus tachycardia; carotid massage and adenosine only temporarily improved the tachycardia. As part of tachycardia work up, thyroid-stimulating hormone was done, which revealed a low level of 0.015; however, free T4 and total T3 were normal (1.2 and 1.36, respectively). Further evaluation with thyroid scan showed low uptake of 1 1.2%, and thyroid-stimulating immunoglobulin was also negative. The patient was transferred to the medical intensive care unit because of worsening symptoms. The patients home medications of mirtazapine and quetiapine, which she was.