7th Indo Global Diabetes Summit and Medicare Expo
Mahatma Gandhi Medical College and Research Institute
Title: Painful limb of the severely hyperglycemic-an unrecognised complication of diabetes mellitus
Objective: To report a case of diabetic muscle infarction,a rare complication of longstanding poorly controlled diabetes melltus.
Case report: We describe a case of a 55-year-old male with a 10 -year history of type 2 diabetes mellitus, who presented to our casualty with complaints of sudden onset of left thigh pain and swelling. On evaluation his blood sugars were elevtated, his glycosylated haemoglobin value was high, ESR was raised, CK value was 1800 U/L. We made a presumptive diagnosis of pyomyositis and initiated intravenous antibiotics,but he showed no improvement. Blood and tissues samples were examined for microorganisms and demonstrated no white blood cells and no organisms. Then an MRI of the limb was considered for further evaluation.
Results: MRI of the thigh revealed edema diffused in the anterior compartment,T1-weighted images demonstrated uniform low-intensity signal enhancement of the affected muscle,T2-weighted images demonstrate high-intensity signal changes in the intra-and perimuscular tissues secondary to edema. Gadollinium-DTPA contrast showed linear areas of decreased signal intensity surrounded by rim-enhancement. A muscle biopsy showed coagulation necrosis in skeletal muscle and thrombosis in the small blood vessels. Thus the final diagnosis of Diabetic muscle infarction was made. He was given supportive treatment and he gradually improved.
Conclusion: DMI is a rare complication of diabetes that is often mistaken for infections such as cellulitis, abscess, polymyositis,traumatic,pyomyositis and necrotizing fasciitis or inflammatory thrombophlebitis. Treatment is supportive care. Although the short-term prognosis is good in these patients, the long-term prognosis is poor.