Diabetic Myonecrosis in a Previously Healthy Woman and Review of a 25-Year Mayo Clinic Experience

doi:10.4158/EP.8.5.343

Endocrine Practice

Volume 8, Issue 5, September–October 2002, Pages 343-346

https://doi.org/10.4158/EP.8.5.343 Get rights and content

ABSTRACT

Objective:

To describe a case of diabetic myonecrosis, an unusual complication of diabetes mellitus, and to provide an overview of an institutional experience with this condition.

Methods:

We report the clinical, laboratory, and imaging findings in a 50-year-old woman with no history of diabetes, who was hospitalized because of weakness in her left lower extremity and an infection in her right hand.

Results:

A morbidly obese woman had sustained several falls attributable to left leg weakness, which had resulted in repetitive trauma to, and subsequent infection of, her right hand. Laboratory studies showed a fasting blood glucose level of 204 mg/dL, a glycated hemoglobin of 12.8%, and a calculated hemoglobin Alc of 10.6%. Results of evaluations for retinopathy and nephropathy were negative. Electromyography of the left leg suggested the presence of a diabetic plexopathy. Two weeks after admission of the patient, severe left lower extremity pain and swelling developed abruptly. Ultrasound evaluation of the leg was negative for deep venous thrombosis. Laboratory data revealed a leukocyte count of 7.1 × 10³/μL and a creatine kinase level of 26 U/L. Magnetic resonance imaging of the left leg demonstrated extensive muscle edema and collections of fluid surrounding the femur and posterior compartment of the thigh and extending into the left calf. Gram stain and cultures of aspirated fluid were negative. The patient was managed with supportive care, including strict glycemic control, periodic analgesia, and physical therapy. A review of medical records for a 25-year period at the Mayo Clinic disclosed only five patients with the diagnosis of diabetic myonecrosis. All five patients had insulin-treated diabetes and severe end-organ disease.

Conclusion:

The current case is the first report of myonecrosis as the initial manifestation of diabetes. This case also demonstrates that myonecrosis, although typically involving the thigh, can extend abruptly to the calf. Diabetic myonecrosis should be included in the differential diagnosis of an acutely painful lower extremity mass in patients with diabetes. (Endocr Pract. 2002;8:343-346)

Section snippets

CASE REPORT

A morbidly obese 50-year-old woman (weight 127 kg, height 138 cm, body mass index 67 kg/m²) without a medical history was admitted to the hospital for a persistent infection in her right hand and progressive weakness in her left lower extremity. She had sustained several falls during the previous 2 weeks as a result of her left leg weakness, which had caused repetitive trauma to, and subsequent infection of, her right hand. Before the falls, she had not noticed lower extremity weakness. During

MAYO CLINIC EXPERIENCE

A review of the Mayo Clinic medical records for a 25-year period revealed five patients diagnosed with diabetic myonecrosis (Table 1). All five patients had insulin-treated diabetes and severe end-organ disease. On initial assessment, all patients had severe motion-dependent pain in the lower extremity. Imaging studies in these patients prompted the aspiration of fluid, which was subsequently culture negative. Only one patient had a confirmatory muscle biopsy suggestive of diabetic myonecrosis.

Important Findings

To our knowledge, the current patient is the first case in which myonecrosis was the presenting feature at the time of diagnosis of diabetes. In addition, our case demonstrates that, although the disease typically is confined to the thigh muscle, it may extend abruptly into the calf. The Mayo Clinic experience confirms previous data that diabetic myonecrosis characteristically occurs in conjunction with other severe end-organ damage from poorly controlled diabetes. These data suggest that

CONCLUSION

Diabetic myonecrosis is an uncommon complication of diabetes mellitus despite a high prevalence of the disease. This case demonstrates that myonecrosis may be the initial manifestation of diabetes mellitus and must be included in the differential diagnosis of an acutely painful lower extremity mass in all patients with diabetes. Furthermore, our case suggests that diabetic myonecrosis may extend abruptly beyond the thigh into the calf. The identification of this disease process is important in

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Original ArticleDiabetic Myonecrosis in a Previously Healthy Woman and Review of a 25-Year Mayo Clinic Experience

ABSTRACT

Objective:

Methods:

Results:

Conclusion:

Section snippets

CASE REPORT

MAYO CLINIC EXPERIENCE

Important Findings

CONCLUSION

Semin Arthritis Rheum.

Lancet.

Am J Med.

Tumoriform focal muscle degeneration in two diabetic patients

Diabetologia.

Infarction of the quadriceps muscle: a complication of diabetic vas-culopathy

South Med J.

Case-of-the-month: painful thigh mass in a young woman; diabetic muscle infarction

Muscle Nerve.

Original Article
Diabetic Myonecrosis in a Previously Healthy Woman and Review of a 25-Year Mayo Clinic Experience