Diabetic muscle infarction with pelvic vein thrombosis: An uncommon presentation to the emergency department

Abstract

Diabetic muscle infarction (DMI) occurs as a rare complication associated with long-standing, poorly controlled diabetes mellitus (DM) and typically presents as acute painful muscle swelling in the absence of trauma. It resolves spontaneously over a few weeks to months in most patients and generally has a good prognosis. However, the coexistence of deep vein thrombosis (DVT) with DMI may have an additional risk of complications such as pulmonary embolism, recurrent DVT, and post-thrombotic syndrome (PTS). Although the treatment for DMI is mainly analgesia, rest, and control of diabetes, the coexistence of extensive DVT and diabetic ketoacidosis (DKA) may demand anticoagulation and a multidisciplinary team approach. Its management may also involve the endocrinologist, hematologist, and occasionally an interventional radiologist or vascular surgeon. We report two cases of patients with DMI with extensive DVT that presented to our emergency department (ED) as acute non-traumatic swelling of the lower limb. The diagnosis of DMI in both the cases was based on the presence of characteristic clinical features and typical magnetic resonance imaging (MRI) findings. The patients were treated with anticoagulation therapy in addition to the management of DKA, and discharged with good recovery.