Diabetic muscle infarction: a systematic review

Abstract

ContextDiabetic muscle infarction (DMI) is a rare complication associated with poorly controlled diabetes mellitus. Less than 200 cases have been reported in the literature since it was first described over 45 years ago. There is no clear ‘standard of care’ for managing these patients.Evidence acquisitionPubMed searches were conducted for ‘diabetic muscle infarction’ and ‘diabetic myonecrosis’ from database inception through July 2014. All articles identified by these searches were reviewed in detail if the article text was available in English.Evidence synthesisThe current literature exists as case reports or small case series, with no prospective or higher-order treatment studies available. Thus, an evidence-based approach to data synthesis was difficult. The available literature is presented objectively with an attempt to describe clinically relevant trends and findings in the diagnosis and management of DMI.ConclusionsEarly recognition of DMI is key, so appropriate treatment can be initiated. MRI is the radiological study of choice. A combination of bed rest, glycemic control, and non-steroidal anti-inflammatory drug therapy appears to yield the shortest time to symptom resolution and the lowest risk of recurrence.

Risking Life and Limb: A Case of Spontaneous Diabetic Muscle Infarction (Diabetic Myonecrosis)

“…9 Physicians should also be cautioned that physical therapy should be avoided until the lesion is fully healed, as this may also prolong recovery time. 3,9 Although patients frequently recover from diabetic muscle infarction, this entity is a poor prognostic indicator of longterm clinical outcomes. Studies indicate that most patients suffer serious complications, including death, within five years of diagnosis.…”

“…Fibrin occlusion of arterioles and capillaries may also be seen. 9 Tight glycemic control is the mainstay of treatment, as hyperglycemia has an effect on the remodeling of vasculature, platelet function, and coagulation factors, which may contribute to diabetic muscle infarction. Patients should also be encouraged to rest the affected limb in the acute period.…”

Clinics in diagnostic imaging (179)

“…(11,12) In the absence of relevant clinical history and laboratory markers, radiological findings of rhabdomyolysis may be difficult to distinguish from those of inflammatory myopathy, muscle infection, necrotising fasciitis or other conditions associated with myonecrosis such as diabetes mellitus or sickle cell crisis. (5,6,9,(13)(14)(15)(16)(17)(18) Nonetheless, certain clinical clues and radiological patterns may help to guide imaging interpretation. For example, inflammatory myopathies secondary to autoimmune causes, such as polymyositis or dermatomyositis, usually present with slowly progressive onset of weakness and classically involve the symmetrical proximal muscles, which appear hyperintense on fluid-sensitive sequences (e.g.…”

“…(17) MR imaging findings in acute cases of diabetic myonecrosis include significant muscle oedema and post-contrast enhancement surrounding irregular, and occasionally mass-like, areas of muscle necrosis (Figs. 5a & b).…”

Acute myonecrosis on MRI: etiologies in an oncological cohort and assessment of interobserver variability

“…Acute muscle necrosis (myonecrosis) has commonly been described in the context of poor glycemic control in diabetic patients [1]. Diabetic myonecrosis manifests on MRI as a poorly defined, mass-like region of hyperintense signal on T2-weighted images and isointense to hypointense signal on T1-weighted images; associated perifascial, perimuscular, or subcutaneous edema may also be seen, usually in a lower extremity [1–3].…”