Diabetic Muscle Infarction-A Rare Diabetic Complication: Literature Review and Case Report

Abstract

We present a case of a 31-year-old patient with type 1 diabetes diagnosed at the age of 6. Diabetes is complicated with neuropathy, retinopathy, and nephropathy. He has been admitted to the diabetes ward due to inadequate diabetes control. Gastroscopy and abdominal CT were performed, and gastroparesis was confirmed as an explanation for postprandial hypoglycemia. During hospitalization, the patient reported sudden pain localized on the lateral, distal part of his right thigh. The pain occurred at rest and was aggravated by movement. Diabetic muscle infarction (DMI) is a rare complication of long-lasting, uncontrolled diabetes mellitus. It usually occurs spontaneously, without any previous infection or trauma, and is often misdiagnosed clinically as an abscess, neoplasm, or myositis. DMI patients suffer from pain and swelling of the affected muscles. Radiological examinations, including MRI, CT, and USG, are most important for the diagnosis, assessing the extent of involvement and differentiating DMI from other conditions. However, sometimes a biopsy and histopathological examination are necessary. The optimal treatment has still not been determined. There is also a potential risk of DMI recurrence.

Keywords: diabetic microangiopathy; diabetic muscle infarction; insulin-dependent diabetes mellitus complication.

Figure 1

Oval lesion revealed in USG of the right thigh.

Figure 2

Right thigh CT after contrast administration revealed the fluid collection of degradation in posterior muscle compartment—arrow.

Figure 3

Histopathological presentation. (A) Areas of muscle necrosis and edema with extravasation of blood (HE, ×100). (B) Necrotic muscle fibers with focal replacement of necrotic fibers by loose fibrotic tissue (HE, ×200). (C) Early fibrotic tissue with mononuclear cell infiltration (HE, ×200). (D) Signs of muscle fiber regeneration with scanty lymphocytic infiltrates (HE, ×100).