SHM Converge Scientific Abstract ePoster Gallery-A Hospitalist's Hickam's Dictum: Co-Occurring Osmotic Demyelination and Diabetic Myonecrosis

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This case describes a 44-year-old man with poorly controlled type 2 diabetes who presented with 7 months of bilateral leg pain and swelling, worsened over 2 weeks with falls, plus 1 month of dysarthria and dysphagia. Exam showed lower-extremity edema, weakness, hyporeflexia, sensory deficits, and slurred/stuttering speech. Labs revealed marked hyperglycemia (glucose 433 mg/dL), very poor long-term control (HbA1c 12.2), leukocytosis, and elevated inflammatory markers (ESR 120, CRP 191).<br /><br />Imaging identified two rare diabetes-related complications occurring together: MRI brain showed bilateral pontine restricted diffusion and T2/FLAIR hyperintensity consistent with osmotic demyelination syndrome (ODS), and MRI of the left femur showed changes concerning for diabetic myonecrosis. Other workup, including chest X-ray, EKG, CT head, Doppler ultrasound for DVT, and echocardiogram, was unrevealing.<br /><br />ODS is classically linked to rapid osmolar shifts and can cause neurologic symptoms such as dysarthria, dysphagia, and weakness. Diabetic myonecrosis is an uncommon complication of long-standing diabetes, typically presenting with acute or subacute painful swelling of a lower extremity in patients with microvascular disease; diagnosis is supported by elevated inflammatory markers and MRI. In this patient, diabetic myonecrosis likely contributed to his falls.<br /><br />He was treated with aspirin, glucose control, and rehabilitation therapy. The case emphasizes the need to keep a broad differential in patients with poorly controlled diabetes and unexplained neurologic or musculoskeletal symptoms, and highlights the importance of careful inpatient glucose management and outpatient follow-up to prevent severe complications.

Asset Subtitle

Kavita Renduchintala

Meta Tag

Author List Kavita Renduchintala, Marissa G. Korte

Category Clinical Vignettes

Concept Osmotic Demyelination Syndrome

Concept Diabetic Myonecrosis

Concept Hyperglycemia

Concept Diabetes Mellitus

Concept Osmolarity

Distinguished Non-Finalist

Presenter Organization Section of Hospital Medicine, the University of Chicago Medicine

Presenting Author Kavita Renduchintala

Track Adult

Keywords

type 2 diabetes

osmotic demyelination syndrome

diabetic myonecrosis

hyperglycemia

dysarthria

dysphagia

bilateral leg pain

MRI brain

elevated inflammatory markers

poor glycemic control

Osmotic Demyelination Syndrome

Diabetic Myonecrosis

Hyperglycemia

Diabetes Mellitus

Osmolarity