Case ReportDiabetic Muscle Infarction of the Forearm in a Patient with Long-Standing Type 1 Diabetes
Section snippets
INTRODUCTION
Diabetic muscle infarction (DMI) is a rare, and often underrecognized, complication of poorly controlled diabetes. It occurs in patients with end-organ complications, including neuropathy, nephropathy, and retinopathy. Patients classically present with acute pain and edema in the involved muscle. The lower extremities are typically affected. We describe a case of upper extremity muscle infarction in a patient with type 1 diabetes mellitus who had multiple end-organ complications. The diagnosis
CASE REPORT
A 41-year-old man with a history of type 1 diabetes mellitus initially presented with a 1-week history of painful swelling of the left forearm. Three weeks before the current presentation, he had had an episode of severe hypoglycemia necessitating emergent intravenous access. He described gradually worsening pain and swelling but had no systemic complaints including fever or chills. His symptoms did not diminish with a 5-day course of cephalexin.
The patient had a history of uncontrolled type 1
DISCUSSION
DMI is a rare and often underrecognized complication of diabetes. It was first described in 1965 by Angervall and Stener (2) as “tumoriform focal muscular degeneration.” Since then, more than 100 cases have been reported. DMI usually occurs in patients with poorly controlled diabetes complicated by microvascular disease, including nephropathy, neuropathy, and retinopathy (3). The condition is more commonly seen in women than in men (3,4). A recent systematic review of reported cases found that
CONCLUSION
DMI is an underrecognized complication of diabetes. It can have unusual initial manifestations, and clinicians should be aware of DMI as a diagnostic possibility in the assessment of patients with diabetes, extremity pain, and edema regardless of whether the upper or lower limbs are involved. It should especially be considered in those patients with end-organ complications of their disease. MRI is perhaps the most useful diagnostic procedure, although muscle biopsy may be necessary in atypical
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