J Korean Diabetes.  2016 Mar;17(1):67-72. 10.4093/jkd.2016.17.1.67.

A Case of Bilateral Diffuse Diabetic Muscle Infarction of the Thighs in a Patient with Good Glucose Control

• Lee HJ
• Kim HJ
• Hwang SY
• Kim MK
• Kwon HS
• Baek KH
• Song KH
• Yun KJ

• KMID: 2161134
• DOI: http://doi.org/10.4093/jkd.2016.17.1.67

Abstract

Diabetic muscle infarction (DMI) is a rare condition that usually occurs in diabetic patients who have longstanding microvascular complication. The typical presentation is a painful swelling with abrupt onset in the lower limbs, particularly involving hyper-intense signals in T2-weighted magnetic resonance imaging (MRI) images. The treatment consists of bed rest, analgesics, and physical therapy. The authors encountered a case of DMI with bilateral tender swelling on the anteromedial aspect of the thighs. DMI is less likely to develop in patients with good glycemic control. Recently, however, a few cases demonstrated that DMI can also develop in patients with good glucose control. However, diffuse and extensive infarction of muscle, such as in our case, is rare. It is important to consider differential diagnoses in order to avoid misdiagnosis and non-essential treatment such as overuse of antibiotics or steroid treatment. In this case, we diagnosed the patient using MRI, muscle biopsy, and electromyography and successful treatment involved bed rest and analgesics. We herein report a case of 76-year-old man with very extensive and diffuse DMI in spite of well-controlled type 2 diabetes.

Keyword

Diabetes complications; Diabetes mellitus; Infarction

MeSH Terms

Aged
Analgesics
Anti-Bacterial Agents
Bed Rest
Biopsy
Diabetes Complications
Diabetes Mellitus
Diagnosis, Differential
Diagnostic Errors
Electromyography
Glucose*
Humans
Infarction*
Lower Extremity
Magnetic Resonance Imaging
Thigh*
Analgesics
Anti-Bacterial Agents
Glucose

Figure

• 

  Fig. 1. Magnetic resonance imaging of the patient's thighs shows extensive muscle edema, unevenly and bilaterally involving all visualized muscles of the thighs. Overlying soft tissue and skin thickening are seen prominently on the right. (A) Coronal T2-weighted image demonstrating increased signal intensity in both involved muscles. (B) Coronal T1-weighted image showing decreased signal intensity in both involved muscles.

• 

  Fig. 2. Biopsy of the left skeletal muscle showing focal interstitial infiltration of lymphocytes (H&E stain, × 40).

Reference

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