Diabetic Muscle Infarction After Kidney and Pancreas Transplanation: Case Report and Literature Review

Theodoropoulou, Eleni; Chelioti, Eleni; Revenas, Konstantinos; Katsilambros, Nikolaos; Kostakis, A.; Boletis, John

doi:10.1016/j.transproceed.2006.08.093

Cited by 10 publications

(5 citation statements)

References 25 publications

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“…In addition, the presence of endothelial dysfunction in patients with diabetes mellitus in addition to hypercoagulability resulting from alterations in the coagulationfibrinolytic system has been proposed (6, 10, 12). However, due to the rarity of the condition, the association between antiphospholipid antibody syndrome and DMI has not been proven (10). In the present case, no abnormalities in the coagulation system or levels of phospholipid antibodies were detected.…”

Section: Discussioncontrasting

confidence: 59%

“…Measurements of CK may be normal or elevated depending on the timing of blood sampling and amount of muscle involved (10).…”

Section: Discussionmentioning

confidence: 99%

“…Other modalities suggested to be beneficial include the administration of low-dose aspirin, pentoxifylline, nifedipine, dipyridamole, nonsteroidal agents and anticoagulants. However, there are no randomized control trials to support the use of these agents (6,10,12). In general, the short-term prognosis is reported to be benign, although the long-term outcome is discouraging.…”

Section: Discussionmentioning

confidence: 99%

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Multifocal Diabetic Muscle Infarction: A Rare Complication of Poorly Controlled Diabetes Mellitus

Chebbi¹,

Jerbi²,

Klii

et al. 2014

Intern. Med.

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Diabetic muscle infarction (DMI) is a rare complication of long-standing poorly controlled diabetes mellitus. We herein describe the case of a 56-year-old man with a 10-year history of poorly controlled type 2 diabetes mellitus with multiple microvascular and macrovascular complications who presented with the sudden onset of left thigh pain and swelling. MRI suggested muscle infarction. A muscle biopsy demonstrated coagulation necrosis in the skeletal muscle with inflammation and infarction in the walls of small blood vessels. Physicians should consider DMI in the differential diagnosis of patients with diabetes who present with painful, swollen muscles without systemic signs of infection.

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Section: Discussioncontrasting

confidence: 59%

“…Measurements of CK may be normal or elevated depending on the timing of blood sampling and amount of muscle involved (10).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Multifocal Diabetic Muscle Infarction: A Rare Complication of Poorly Controlled Diabetes Mellitus

Chebbi¹,

Jerbi²,

Klii

et al. 2014

Intern. Med.

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“…White cell count (WCC) values were reported in 35 cases but only 31.4% were elevated (Table 2 ). One patient was found to be leucopenic[ 15 ]. Inflammatory markers are commonly increased in DMI.…”

Section: Investigationsmentioning

confidence: 99%

Diabetic muscle infarction in end-stage renal disease: A scoping review on epidemiology, diagnosis and treatment

Yong

Khow

2018

WJN

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Diabetic muscle infarction (DMI) refers to spontaneous ischemic necrosis of skeletal muscle among people with diabetes mellitus, unrelated to arterial occlusion. People with DMI may have coexisting end-stage renal disease (ESRD) but little is known about its epidemiology and clinical outcomes in this setting. This scoping review seeks to investigate the characteristics, clinical features, diagnostic evaluation, management and outcomes of DMI among people with ESRD. Electronic database (PubMed/MEDLINE, CINAHL, SCOPUS and EMBASE) searches were conducted for (“diabetic muscle infarction” or “diabetic myonecrosis”) and (“chronic kidney disease” or “renal impairment” or “dialysis” or “renal replacement therapy” or “kidney transplant”) from January 1980 to June 2017. Relevant cases from reviewed bibliographies in reports retrieved were also included. Data were extracted in a standardized form. A total of 24 publications with 41 patients who have ESRD were included. The mean age at the time of presentation with DMI was 44.2 years. Type 2 diabetes was present in 53.7% of patients while type 1 in 41.5%. In this cohort, 60.1% were receiving hemodialysis, 21% on peritoneal dialysis and 12.2% had kidney transplantation. The proximal lower limb musculature was the most commonly affected site. Muscle pain and swelling were the most frequent manifestation on presentation. Magnetic resonance imaging (MRI) provided the most specific findings for DMI. Laboratory investigation findings are usually non-specific. Non-surgical therapy is usually used in the management of DMI. Short-term prognosis of DMI is good but recurrence occurred in 43.9%. DMI is an uncommon complication in patients with diabetes mellitus, including those affected by ESRD. In comparison with unselected patients with DMI, the characteristics and outcomes of those with ESRD are generally similar. DMI may also occur in kidney transplant recipients, including pancreas-kidney transplantation. MRI is the most useful diagnostic investigation. Non-surgical treatment involving analgesia, optimization of glycemic control and initial bed rest can help to improve recovery rate. However, recurrence of DMI is relatively frequent.

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“…We reviewed the literature and discussed 48 episodes of DMInf in 30 patients with CKD-Vd [3–16]. Mean and median age at time of diagnosis of DM was 28.1 and 30.5 years respectively, and DMInf occurred at a mean and median age of 46.0 and 49.0 years.…”

Section: Discussionmentioning

confidence: 99%

Diabetic Muscle Infarction: A Rare Cause of Acute Limb Pain in Dialysis Patients

Vlieger

Bammens

Claus

et al. 2013

Case Reports in Nephrology

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Diabetic muscle infarction is a rare microangiopathic complication occurring in patients with advanced diabetes mellitus. Diabetic patients with chronic kidney disease stage Vd are prone to develop this complication. The presenting symptom is a localized painful swelling of the affected limb. Symptoms usually resolve spontaneously during the following weeks, but frequent relapse can occur and in some cases swelling may lead to compartment syndrome. Biochemical blood analyses show an elevated C-reactive protein, but creatine kinase is often normal. Diagnosis can be made on clinical presentation and imaging, with magnetic resonance imaging as the gold standard. Histology is often not contributive. Treatment consists of rest, analgesics, rigorous glycemic control and low-dose aspirin. Severe cases of compartment syndrome require fasciotomy. In the current paper, we present two diabetic patients with cystic fibrosis, who are treated with automated peritoneal dialysis and suffered from episodic lower limb infarction. We subsequently review 48 episodes of diabetic muscle infarction previously reported in the literature in patients with end-stage renal disease.

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Diabetic Muscle Infarction After Kidney and Pancreas Transplanation: Case Report and Literature Review

Cited by 10 publications

References 25 publications

Multifocal Diabetic Muscle Infarction: A Rare Complication of Poorly Controlled Diabetes Mellitus

Multifocal Diabetic Muscle Infarction: A Rare Complication of Poorly Controlled Diabetes Mellitus

Diabetic muscle infarction in end-stage renal disease: A scoping review on epidemiology, diagnosis and treatment

Diabetic Muscle Infarction: A Rare Cause of Acute Limb Pain in Dialysis Patients

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