Abstract
Diabetic muscle infarction is a rare complication of diabetes mellitus that presents as a localized, exquisitely painful swelling and limited range of motion of the involved extremity. The onset is usually acute, persists for several weeks and resolves spontaneously over several weeks to months without the need for intervention. However, as diabetes mellitus is an immunocompromised state and any painful swelling in the limbs is often taken as infectious in aetiology, the patient is inadvertently investigated with invasive procedures and is started on unnecessary antibiotics, adding to the burden of management. Keeping in view the low threshold for starting antibiotics in painful limb swelling in diabetes mellitus in our setting, we hereby describe a case of recurrent painful diabetic muscle infarction, first involving the right upper and later the right lower limb, managed with physical rest and analgesics. This case emphasizes that the treating physician keep this rare complication of diabetes mellitus in consideration in the respective clinical scenario and adopt a less aggressive (a noninvasive method like ultrasound) rather than a more aggressive (an invasive method like muscle biopsy) approach in diagnosis and take a similar approach towards management.
Highlights
Diabetic muscle infarction (DMI) is a rare cause of acute severe muscle pain in patients with longstanding diabetes mellitus, with other microvascular and macrovascular complications in many of them, presenting to rheumatologists, endocrinologists, orthopaedic surgeons and physicians
We describe a case of recurrent unexpected acute muscle pain in the right forearm and the right thigh due to DMI in a long-standing type 2 diabetic female patient, with tripathy successfully managed by conservative treatment
The patient was initially started on intravenous antibiotics and analgesics in addition to the treatment for diabetes and hypertension, but later antibiotics were stopped in view of the ultrasound and MRI findings suggestive of muscle necrosis
Summary
Diabetic muscle infarction (DMI) is a rare cause of acute severe muscle pain in patients with longstanding diabetes mellitus, with other microvascular and macrovascular complications in many of them, presenting to rheumatologists, endocrinologists, orthopaedic surgeons and physicians. The patient was initially started on intravenous antibiotics and analgesics in addition to the treatment for diabetes and hypertension, but later antibiotics were stopped in view of the ultrasound and MRI findings suggestive of muscle necrosis Her symptoms improved gradually over a period of 2 weeks, and she was discharged after she had been pain-free without analgesics. Axial T1-weighted image with contrast of the right forearm showing patchy heterogeneous enhancement haemodynamically stable and had a discrete swelling on the anterior aspect of the right thigh, which was warm and tender. Her counts were normal, erythrocyte sedimentation rate and C-reactive protein were increased with a mild elevation of creatinine phosphokinase 219, and plain radiograph of the right thigh was normal. She was discharged and could walk with support
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