Diabetic Muscle Infarction

Abstract

Diabetic muscle infarction is a rare complication of long-standing, poorly controlled diabetes mellitus in patients with microvascular complications of nephropathy, retinopathy, and neuropathy. Typical presentation is the acute onset of severe pain, swelling, and tenderness of affected muscles in a patient with diabetes. Diagnosis is made by history and physical examination and characteristic findings of increased signal intensity of affected muscles on T2-weighted magnetic resonance imaging. Muscle biopsy of affected muscle is rarely indicated. Suggestive laboratory findings include an elevated serum creatine phosphokinase and elevated Westergren erythrocyte sedimentation rate. Management is conservative. The patient could have recurrence in weeks to months. Although patients usually recover in approximately 4 weeks, life expectancy after an episode of diabetic muscle infarction is usually limited as a result of other complications of diabetes. Learning Objectives• Identify the characteristics of diabetics who develop muscle infarction on the basis of 135 reported patients. • Recall the clinical, laboratory, and imaging findings in patients with diabetic muscle infarction (DMI). • Summarize management options for patients with DMI and the usual course of this disorder.S pontaneous diabetic muscle infarction (DMI) is a rare complication of long-standing, poorly controlled diabetes mellitus. This condition was first described by Angerveld and Stener in 1965 as "tumoriform focal muscular degeneration." 1 This clinical entity has also been described as diabetic myonecrosis, ischemic myonecrosis, aseptic myonecrosis, and atraumatic muscular infarction.The diagnosis of DMI can usually be made with a good history and physical examination and increased signal intensity on T2-weighted magnetic resonance imaging (MRI). 2 Although biopsy could be performed (if diagnosis is unclear), it is rarely necessary and can be nonspecific. 3 CASE REPORTA 78-year-old man with a history of type 2 diabetes mellitus for 20 years with neuropathy and nephropathy presented to the emergency department with a 1-day history of severe right thigh pain. The patient also admitted to vague pain in his left thigh of the same duration. He also complained of weakness, malaise, subjective fever and chills, polyuria, and dysuria. The thigh pain was most severe in the distal right quadriceps, sudden in onset, worse with movement, and nonradiating. The patient denied trauma, recent travel, weight loss, intravenous drug use, alcoholism, rash, or numbness of the extremities. Medications at the time of presentation included simvastatin, glipizide, terazosin, and nifedipine.Temperature was 100.4°F, pulse was 115 beats/min, blood pressure was 149/63 mm Hg, and respiratory rate was 12 breaths/min. On examination, the right distal quadriceps was mildly swollen, warm, mildly erythematous, and very tender to palpation. Strength was 3/5, limited by pain. The distal left quadriceps was slightly warm and tender to palpation; strength was 4/5, also limited by pain. D...

Diabetic myonecrosis in a patient with hepatic cirrhosis: a case report and review of the literature

“…Long-term diabetic vasculopathy is essential for developing diabetic myonecrosis [4]. Classically, it has been reported in women with long-standing diabetes (15 years from diagnosis); type 1 diabetes is present in most cases (71%) [1,2,5]. In type 2 diabetes cases, it characteristically affects elderly patients.…”

“…A palpable mass occurs in 40% of patients at presentation. Nerve compression is rare and motility restriction of the limb is a result of intense pain [5,7]. The quadriceps cruralis is the most commonly involved muscle (87%) and the vastus lateralis and vastus medialis are implicated in 24% and 22%, respectively.…”

“…Creatine phosphokinase levels are normal or slightly elevated in 52%; leukocytosis occurs in 14% of cases. AST, ALT, LDH levels and the erythrocyte sedimentation rate are normal most times [8,5]. Deep vein thrombosis is the main differential diagnosis.…”