SHM Converge Scientific Abstract ePoster Gallery-"I'm Not Pulling Your Leg!" Perplexing Pain in a Patient With Diabetes

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A 59-year-old man with diabetes, peripheral vascular disease, coronary artery disease, and hypertension presented with one week of progressive right leg pain, swelling, and weakness, most severe in the thigh, hip, and buttock, followed by new numbness in the foot and ankle. He denied trauma or new medications. Exam showed marked tenderness of the right thigh, sensory loss in the shin and foot, and reduced strength. Labs revealed mildly elevated WBC, elevated CK, and markedly elevated ESR and CRP. X-rays, venous ultrasound, and CT were unrevealing aside from diffuse edema.<br /><br />Because he was on dual antiplatelet therapy, only a fine-needle muscle biopsy was performed; gram stain and cultures were negative. Neurology considered statin myositis, but EMG showed distal axonal polyneuropathy without inflammatory myopathy. Orthopedics did not think he had necrotizing fasciitis or compartment syndrome. MRI of the thigh demonstrated edema in the vastus lateralis, vastus medialis, and gluteus maximus, consistent with diabetic myonecrosis.<br /><br />Diabetic myonecrosis, also called diabetic muscle infarction, is a rare ischemic necrosis of skeletal muscle seen in patients with diabetes, usually affecting the lower extremity. It can mimic infection, DVT, malignancy, myositis, or hematoma. MRI is the preferred diagnostic test, and muscle biopsy is usually unnecessary except in unclear cases. Management is supportive, with rest, pain control, and glycemic optimization; NSAIDs may help, while physical therapy can prolong recovery.<br /><br />The case highlights the importance of including diabetic myonecrosis in the differential diagnosis of unexplained limb pain in patients with diabetes, and of using MRI early to avoid unnecessary invasive testing.

Asset Subtitle

Lydia Bunker

Meta Tag

Author List Alexander F. Barbuto, Lydia Bunker

Category Clinical Vignettes

Concept Diabetic Myonecrosis

Concept Magnetic Resonance Imaging

Concept Intramuscular Edema

Concept Diabetes Mellitus

Concept Acute Extremity Pain

Distinguished Non-Finalist

Presenter Organization Baylor Scott & White Medical Center

Presenting Author Lydia Bunker

Track Adult

Keywords

diabetic myonecrosis

diabetic muscle infarction

right leg pain

muscle edema

MRI diagnosis

diabetes mellitus

peripheral vascular disease

elevated CK

muscle biopsy

lower extremity pain

Diabetic Myonecrosis

Magnetic Resonance Imaging

Intramuscular Edema

Diabetes Mellitus

Acute Extremity Pain