An unexpected cause of muscle pain in diabetes

Abstract

Diabetic muscle infarction is a rare condition which may present to a rheumatologist. It was first reported in 1965. Two illustrative cases are described here and the mechanisms of pathogenesis discussed. Analysis of the published data, results of the muscle biopsies, and a technetium-99m sestamibi scan suggest that the condition, which occurs against a background of diabetic microangiopathy, can be triggered by an ischaemic event and causes extensive muscle necrosis through hypoxia-reperfusion injury and compartment syndrome.

Figure 1

T₂ weighted magnetic resonance image. An increased signal density in the right vastus lateralis muscle can be seen.

Figure 2

Dynamic ^99mTc-sestamibi scan. Increased tracer uptake at the site of the lesion in the right thigh is seen.