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Spontaneous diabetic myonecrosis: report of four cases from a tertiary care institute.

Mukherjee S, Aggarwal A, Rastogi A, Bhansali A, Prakash M, Vaiphei K, Dutta P - Endocrinol Diabetes Metab Case Rep (2015)

Bottom Line: Conservative management including rest and analgesics is the treatment of choice.Short-term prognosis is good but there may be recurrence.A high index of suspicion is required for the diagnosis of DMN which can avoid inadvertent use of antibiotics.Acute-subacute onset severe focal muscle pain in the absence of systemic symptoms in a female patient with long-standing diabetes with microvascular complications suggests DMI.MRI is the most sensitive test for diagnosis.Muscle biopsy should be reserved for atypical cases.Conservative management including rest and analgesics has good outcome.Improvement usually occurs within 6-8 weeks, but there may be recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology , Post Graduate Institute of Medical Education and Research , Chandigarh, 160012 , India.

ABSTRACT

Unlabelled: Spontaneous diabetic muscle infarction (DMI) is a rare and under diagnosed complication of diabetes mellitus. Clinically it presents with acute to subacute onset swelling, pain and tenderness of muscle(s) without systemic manifestations. MRI is helpful in diagnosis, exclusion of other causes and for localization of affected muscle for biopsy in atypical cases. Muscles of the thighs are commonly affected in diabetic myonecrosis (DMN). Here we present the summary of four cases seen in the last 3 years in a tertiary care centre with simultaneous or sequential involvement of multiple groups of muscles or involvement of uncommon sites. All these patients had advanced duration of diabetes with microvascular complications and poor glycemic control. Conservative management including rest and analgesics is the treatment of choice. Short-term prognosis is good but there may be recurrence.

Learning points: A high index of suspicion is required for the diagnosis of DMN which can avoid inadvertent use of antibiotics.Acute-subacute onset severe focal muscle pain in the absence of systemic symptoms in a female patient with long-standing diabetes with microvascular complications suggests DMI.MRI is the most sensitive test for diagnosis.Muscle biopsy should be reserved for atypical cases.Conservative management including rest and analgesics has good outcome.Improvement usually occurs within 6-8 weeks, but there may be recurrence.

No MeSH data available.


Related in: MedlinePlus

(a) Swelling of muscle of right thigh. (b) T2W fat sat (coronal section) shows hyperintensity of muscle with subcutaneous edema. (c) Post contrast T1W (axial section) showing enhancement with necrotic areas in the muscle.
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fig2: (a) Swelling of muscle of right thigh. (b) T2W fat sat (coronal section) shows hyperintensity of muscle with subcutaneous edema. (c) Post contrast T1W (axial section) showing enhancement with necrotic areas in the muscle.

Mentions: A 48-year-old female, presented with pain and swelling over her left thigh for the last 3 months and over right thigh for the last 2 weeks (Fig. 2a). There was history of similar painful swelling over right thigh 1 year back which resolved spontaneously. She did not have constitutional symptoms. There was no history of antecedent trauma or i.m. injection. She was a known case of T2DM for the last 24 years with neuropathy, retinopathy and nephropathy, and was on continuous ambulatory peritoneal dialysis for end stage renal disease. Her right and left thigh muscles were swollen and tender. Patient had hemoglobin of 7.1 g/dl, TLC of 14 900/mm3, creatinine 7.64 mg/dl. Coagulation profile was normal and workup for connective tissue disorder was negative. Colour Doppler study excluded deep vein thrombosis of lower limb. On USG, anterolateral muscles of bilateral thigh and anterolateral muscles of left leg were bulky and heterogonous. MRI performed 3 months prior, revealed bulky muscle group on medial aspect of left thigh with increased intensity on T2-weighted sequence. Post contrast study revealed heterogeneous enhancement with a small noncontrast enhanced necrotic region suggestive of myonecrosis (Fig. 2b and c). Insulin therapy was optimized and i.v. iron sucrose, vitamin B12 and erythropoietin were administered for anemia. She was managed conservatively with codeine and paracetamol for 6 weeks.


Spontaneous diabetic myonecrosis: report of four cases from a tertiary care institute.

Mukherjee S, Aggarwal A, Rastogi A, Bhansali A, Prakash M, Vaiphei K, Dutta P - Endocrinol Diabetes Metab Case Rep (2015)

(a) Swelling of muscle of right thigh. (b) T2W fat sat (coronal section) shows hyperintensity of muscle with subcutaneous edema. (c) Post contrast T1W (axial section) showing enhancement with necrotic areas in the muscle.
© Copyright Policy - license
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4482157&req=5

fig2: (a) Swelling of muscle of right thigh. (b) T2W fat sat (coronal section) shows hyperintensity of muscle with subcutaneous edema. (c) Post contrast T1W (axial section) showing enhancement with necrotic areas in the muscle.
Mentions: A 48-year-old female, presented with pain and swelling over her left thigh for the last 3 months and over right thigh for the last 2 weeks (Fig. 2a). There was history of similar painful swelling over right thigh 1 year back which resolved spontaneously. She did not have constitutional symptoms. There was no history of antecedent trauma or i.m. injection. She was a known case of T2DM for the last 24 years with neuropathy, retinopathy and nephropathy, and was on continuous ambulatory peritoneal dialysis for end stage renal disease. Her right and left thigh muscles were swollen and tender. Patient had hemoglobin of 7.1 g/dl, TLC of 14 900/mm3, creatinine 7.64 mg/dl. Coagulation profile was normal and workup for connective tissue disorder was negative. Colour Doppler study excluded deep vein thrombosis of lower limb. On USG, anterolateral muscles of bilateral thigh and anterolateral muscles of left leg were bulky and heterogonous. MRI performed 3 months prior, revealed bulky muscle group on medial aspect of left thigh with increased intensity on T2-weighted sequence. Post contrast study revealed heterogeneous enhancement with a small noncontrast enhanced necrotic region suggestive of myonecrosis (Fig. 2b and c). Insulin therapy was optimized and i.v. iron sucrose, vitamin B12 and erythropoietin were administered for anemia. She was managed conservatively with codeine and paracetamol for 6 weeks.

Bottom Line: Conservative management including rest and analgesics is the treatment of choice.Short-term prognosis is good but there may be recurrence.A high index of suspicion is required for the diagnosis of DMN which can avoid inadvertent use of antibiotics.Acute-subacute onset severe focal muscle pain in the absence of systemic symptoms in a female patient with long-standing diabetes with microvascular complications suggests DMI.MRI is the most sensitive test for diagnosis.Muscle biopsy should be reserved for atypical cases.Conservative management including rest and analgesics has good outcome.Improvement usually occurs within 6-8 weeks, but there may be recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology , Post Graduate Institute of Medical Education and Research , Chandigarh, 160012 , India.

ABSTRACT

Unlabelled: Spontaneous diabetic muscle infarction (DMI) is a rare and under diagnosed complication of diabetes mellitus. Clinically it presents with acute to subacute onset swelling, pain and tenderness of muscle(s) without systemic manifestations. MRI is helpful in diagnosis, exclusion of other causes and for localization of affected muscle for biopsy in atypical cases. Muscles of the thighs are commonly affected in diabetic myonecrosis (DMN). Here we present the summary of four cases seen in the last 3 years in a tertiary care centre with simultaneous or sequential involvement of multiple groups of muscles or involvement of uncommon sites. All these patients had advanced duration of diabetes with microvascular complications and poor glycemic control. Conservative management including rest and analgesics is the treatment of choice. Short-term prognosis is good but there may be recurrence.

Learning points: A high index of suspicion is required for the diagnosis of DMN which can avoid inadvertent use of antibiotics.Acute-subacute onset severe focal muscle pain in the absence of systemic symptoms in a female patient with long-standing diabetes with microvascular complications suggests DMI.MRI is the most sensitive test for diagnosis.Muscle biopsy should be reserved for atypical cases.Conservative management including rest and analgesics has good outcome.Improvement usually occurs within 6-8 weeks, but there may be recurrence.

No MeSH data available.


Related in: MedlinePlus