Diabetic Myonecrosis: An Unusual Mimicker of Idiopathic Inflammatory Myositis

Sureja, Nayan Patel; Devarasetti, Phani Kumar; Rajasekhar, Liza

doi:10.4997/jrcpe.2020.214

Cited by 4 publications

(1 citation statement)

References 9 publications

(15 reference statements)

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“…The terms diabetic myonecrosis, diabetic myositis, and diabetic muscle infarction all describe the same microangiopathic rare complication associated with poorly controlled diabetes mellitus [1]. Diabetic myonecrosis is so rare that less than 200 cases have been reported [2]. Diabetic myonecrosis usually presents as a confusing picture of proximal lower extremity edema and extreme pain, with non-specific laboratory values.…”

Section: Introductionmentioning

confidence: 99%

In a Changing World of Disease Prevalence, We Must Change Our Differentials: A Case of Diabetic Myonecrosis

Chloe W,

Jon D,

William S

2023

Int J Diabetes Clin Res

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CaSe RepoRtCheck for updates and chills. Prior to presentation, he was treated with antibiotics. On physical exam, the patient was afebrile with a heart rate of 100 beats per min (BPM) and blood pressure of 136/107 mmHg. Physical exam was remarkable for erythema and swelling present from the medial aspect of the left knee to the inguinal crease. Pitting edema was present on the foot, ankle, and leg. An open wound was also present over left second digit amputation site with fibrinopurulent exudate. Dorsal pedal, popliteal and femoral pulses were palpable. The patient did not have a leukocytosis and hemoglobin was low at 11.7 g/dL. Glucose was found to be high at 243 mg/dL and HbA1C > 9%. Creatine Kinase (CK) was normal. C-reactive protein (CRP) was elevated at 42.1 mg/L. Erythrocyte sedimentation rate (ESR) was elevated at > 50 mm/h. Throughout admission, despite IV antibiotic treatment, the patient eventually developed a leukocytosis with peak white blood cell (WBC) 17.2 K/uL, CRP peaked at 157 mg/L, and ESR peaked at 58. The patient was treated with broad-spectrum antibiotics. Computerized tomography (CT) findings of LLE included extensive subcutaneous swelling in the left leg, and no evidence of abscess, necrotizing fasciitis, or acute osteomyelitis. CT pelvis and lumbar spine were completed for increasing concern of left hip and thigh pain, and the most notable findings included continued subcutaneous edema in the left side with possible myositis of the left proximal thigh musculature. Surgery teams assessed the patient and concluded there was no suspicion for large vessel ischemia of LLE or necrotizing fasciitis. Due to ongoing severe pain in LLE, worsening leukocytosis, and tachycardia, magnetic

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Section: Introductionmentioning

confidence: 99%

In a Changing World of Disease Prevalence, We Must Change Our Differentials: A Case of Diabetic Myonecrosis

Chloe W,

Jon D,

William S

2023

Int J Diabetes Clin Res

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Imaging mimickers of MSK infection

Taljanovic,

Omar,

Melville

et al. 2024

Skeletal Radiol

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A new therapeutic approach with tocilizumab in a 39-year-old patient with recurrent diabetic myonecrosis

Wagemann

Keller

Noriega

et al. 2021

Modern Rheumatology Case Reports

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We report the case of a 39-year-old female patient with acute painful swelling of the left thigh and symmetric muscle weakness in both upper legs. The patient had a history of long-standing, poorly controlled type 1 diabetes and required dialysis due to diabetic nephropathy. At admission serum inflammatory markers were highly elevated. MRI showed liquid formation in the adductor magnus muscles, indicating necrotic or inflammatory colliquation. As antibiotic therapy did not lead to clinical improvement anti-inflammatory therapy with prednisolone was initiated which led to rapid improvement. Three months later, the patient presented with a new onset of progressive and painful muscle swelling of the right thigh. MRI showed pronounced swelling of the right adductor muscles and inflammatory markers were massively elevated. In the absence of autoantibodies or any infectious agents and the recurrent symptomatology relapsing diabetogenic, myonecrosis was diagnosed. Initially, clinical improvement could only be achieved with high dose glucocorticosteroids. Intravenous immunoglobulins did not show an effect, whereas serological and clinical remission was achieved after we administered tocilizumab intravenously. Diabetic myonecrosis is a rare complication of long-term, poorly controlled diabetes mellitus. Acute muscle pain and elevated inflammatory markers in diabetes patients should prompt suspicion. Contralateral muscle involvement in the patient history is also suggestive of the disease. The optimisation of diabetes treatment is crucial in order to prevent further disease complications.

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Diabetic Myonecrosis: An Unusual Mimicker of Idiopathic Inflammatory Myositis

Cited by 4 publications

References 9 publications

In a Changing World of Disease Prevalence, We Must Change Our Differentials: A Case of Diabetic Myonecrosis

In a Changing World of Disease Prevalence, We Must Change Our Differentials: A Case of Diabetic Myonecrosis

Imaging mimickers of MSK infection

A new therapeutic approach with tocilizumab in a 39-year-old patient with recurrent diabetic myonecrosis

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