Diabetic muscle infarction: often misdiagnosed and mismanaged

Abstract

Mohamud A Verjee,1 Nael Amin Abdelsamad,2 Salman Qureshi,3,4 Rayaz A Malik1,5 1Department of Medicine, Weill Cornell Medicine – Qatar, Qatar Foundation, Education City, Doha, Qatar; 2Department of Paediatrics, University of Utah, Salt Lake City, UT 84112, USA; 3Department of Radiology, University of Manchester, Manchester M13 9PL, UK; 4Department of Radiology, Hamad Medical Corporation, Doha, Qatar; 5Institute of Cardiovascular Medicine, University of Manchester, Manchester, M13 9PL, UK Abstract: A patient with type 2 diabetes, retinopathy, neuropathy, and nephropathy presented with severe right distal thigh pain, which awoke him from sleep. He was diagnosed with musculoskeletal pain and discharged home. Two days later, the severity of pain increased in his right thigh and, subsequently, he developed pain in the proximal lateral aspect of his left thigh, for which he returned to hospital. He had elevated creatine kinase and myoglobin levels. An ultrasound of the right thigh identified a loss of definition of the normal muscular striations and subcutaneous edema. On MRI, the axial STIR image demonstrated extensive T2 hyperintensity in the right vastus medialis and left vastus lateralis, consistent with the diagnosis of diabetic muscle infarction (DMI). This presentation emphasizes the need for a thorough patient history and physical examination, and the importance of directed imaging for the prompt diagnosis of DMI. Keywords: muscle infarction, edema, microvascular, nephropathy, neuropathy, retinopathy, striations

Keywords

• Muscle infarction
• neuropathy
• microvascular
• edema
• striations.