Diabetic muscle infarction: rare complication with a distinct clinical manifestation

Abstract

Diabetic muscle infarction is an unusual condition with distinctive clinical characteristics seen in patients with prolonged and uncontrolled diabetes. Clinical findings and imaging study are unique and challenging. Patients usually present with acute unilateral severe muscular pain and swelling, particularly in the lower extremities. The presentation is difficult to distinguish from other common conditions such as deep venous thrombosis and infectious myositis. However, early recognition of the clinical presentation and appropriate imaging selection can lead to the diagnosis and avoid unnecessary muscle biopsy. Here, we report a case of diabetic muscle infarction in a patient with poorly controlled type 1 diabetes who had a good clinical response after an early detection and appropriate treatment.

Keywords: diabetes; endocrine system; musculoskeletal and joint disorders.

Figure 1

Axial T1-weighted image shows oedematous change with hypo-to-isosignal intensity.

Figure 2

Axial T2-weighted image shows hyperintense signal intensity represents an area of muscle ischaemia.

Figure 3

Axial postcontrast T1WI shows focal central low-signal intensity surrounded with rim increased signal intensity, represents muscle infarction and necrosis.

Figure 4

Coronal view, postcontrast T1WI shows mixed enhanced and non-enhanced area in linear streak pattern represents muscle infarction. Diffused skin and subcutaneous fat oedema is noted.