An atypical presentation of diabetic myonecrosis.

• Type of Material: Article
• Authors: Francisco Galeano-Valle, Complutense University of Madrid; Estela Benito-Martinez, Ramón y Cajal Hospital; Luis Álvarez-Sala-Walther, Complutense University of Madrid; Gabriela Oprea, Emory University; Guillermo Umpierrez, Emory University; Francisco Javier Pasquel, Emory University
• Language: English
• Date: 2019-01
• Publisher: American Association of Clinical Endocrinologists
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 AACE
• Final Published Version (URL): http://dx.doi.org/10.4158/ACCR-2018-0228
• Title of Journal or Parent Work: AACE Clinical Case Reports
• Volume: 5
• Issue: 1
• Start Page: e77
• End Page: e81
• Grant/Funding Information: F.J.P. is partially supported by NIH/ NIGMS grant: 1K23GM128221-01A1, G.E.U. is partially supported by the Atlanta and Colorado CTSA Programs, NIH/NATS UL1 TR002378 and UL1 TR001082 from the Clinical and Translational Science Award program, 1P30DK111024-01 from the National Institutes of Health and National Center for Research Resources.
• Keywords: creatine phophokinase; acute-phase reactants; microvascular complications; muscle infarction; management; diabetic muscle infarction; hyperintensity; motor deficiency; therapy; acute-onset pain; type 2 diabetes mellitus; diabetes myonecrosis; imaging; ambulation; leukocytosis; swelling
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Objective: Diabetes myonecrosis, also called diabetic muscle infarction (DMI), is a rare complication of diabetes. Given its rarity, our understanding of the underlying causes or the optimal management of DMI cases remains unclear. Methods: We report on a patient who experienced 2 episodes of DMI and we also review the literature. Results: A 46-year-old male with longstanding type 2 diabetes mellitus with multiple microvascular complications presented with acute-onset painful right thigh induration. On physical examination, he had right thigh swelling, tenderness, and crepitus. Blood tests showed leukocytosis, elevated creatine phosphokinase, and elevated acute-phase reactants. Microbiological cultures were negative. Glycated hemoglobin was 6.4% (46 mmol/mol). Magnetic resonance imaging demonstrated T2 hyperintensity involving the quadriceps group. The clinical and laboratory signs suggested a muscle infection. A muscle biopsy was suggestive of DMI. Eleven months later, the patient presented again with a 4-week history of left thigh pain and weakness in both legs. On examination, he had bilateral thigh anterior tenderness without evidence of swelling or induration. He also had marked bilateral proximal motor deficiency and inability to stand or ambulate. Despite a different clinical presentation, imaging features were consistent with DMI. The patient was managed with conservative therapy. His strength improved significantly after 3 months of follow up. Conclusion: The typical clinical presentation of DMI includes unilateral acute-onset pain in the quadriceps, local swelling, and the appearance of a palpable painful mass. The second episode in our patient illustrates an atypical clinical presentation of DMI and shows the importance of the correlation of clinical and imaging findings for the diagnosis of DMI.