J Korean Diabetes.  2020 Dec;21(4):227-234. 10.4093/jkd.2020.21.4.227.

Diabetic Muscle Infarction in a Young Patient with Prader-Willi Syndrome and Type 2 Diabetes Mellitus

• Kwon EJ
• Lee EJ
• Jang HC
• Kang EH
• Lee YJ
• Ha YJ

• KMID: 2511892
• DOI: http://doi.org/10.4093/jkd.2020.21.4.227

Abstract

Diabetic muscle infarction (DMI), also known as diabetic myonecrosis, is a rare complication of diabetes mellitus (DM); hence, it is often underdiagnosed. Thus, timely diagnosis and treatment are essential for a better prognosis. We describe a 24-year-old woman with Prader-Willi syndrome and an 8-year history of uncontrolled type 2 DM, who presented with a sudden onset of fever and subacute painful swelling of her left thigh. She was finally diagnosed with DMI based on magnetic resonance imaging and muscle biopsy after excluding other infectious and inflammatory diseases of proximal muscles. The patient was treated with bed rest, strict glycemic control, and analgesics, and her symptoms gradually resolved. DMI should be considered in the differential diagnosis of patients with poorly controlled DM, who present with subacute pain and swelling of lower extremity muscles, without a history of trauma.

Keyword

Diabetes complications; Infarction; Muscle; Prader-Willi syndrome

Figure

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  Fig. 1. Magnetic resonance imaging of left thigh. (A) Axial T2-weighted image with fat suppression, demonstrating enlargement and diffusely increased signal intensity of the adductor magnus muscle and irregular hypointense area at the center. (B) Coronal T1-weighted, fat-suppressed image with gadolinium enhancement.

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  Fig. 2. Diabetic muscle infarction involving the left thigh showing its enlargement compared with the right thigh.

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  Fig. 3. (A∼C) Biopsy of the left thigh skeletal muscle showing multifocal necrosis of muscle fibers and dens interstitial infiltration of neutrophils and lymphocytes, and panniculitis. H&E stain, ×100; ×200; ×200, respectively. (D∼F) Gram stain, Wright-Giemsa stain, and Periodic acid Schiff stain for detecting bacteria and fungus were negative. ×200.

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