SHM Converge Scientific Abstract ePoster Gallery-Consider Skipping Leg Day: An Unexpected Case of Diabetic Myonecrosis

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This case describes diabetic myonecrosis (DMN), a rare complication of long-standing, poorly controlled diabetes that usually presents with acute thigh pain and swelling without fever or obvious trauma. A 60-year-old woman came to the ED with 6 days of worsening right thigh pain and swelling that began after minor blunt trauma during a long car trip. She had no known diabetes, no routine medical care, and no history of DVT/PE.<br /><br />On exam, she had marked tenderness and swelling of the anteromedial thigh, but no warmth, redness, skin discoloration, or tightness. Initial labs showed hyperglycemia (glucose 345 mg/dL), elevated HbA1c (14.0%), mildly elevated CPK, and a normal WBC. CT imaging showed enlargement and hypoattenuation of the vastus lateralis muscle with surrounding edema, findings consistent with DMN. She was initially treated with enoxaparin and IV fluids because DVT and vascular disease were considered.<br /><br />Her symptoms improved with diabetes management and supportive care, but worsened after she exercised in the hospital, which prompted repeat imaging and confirmed the diagnosis of diabetic myonecrosis. She was discharged to recuperative care with instructions for rest, diabetes education, and follow-up.<br /><br />The report highlights that DMN is often misdiagnosed as infection, DVT, hematoma, or rhabdomyolysis. MRI with contrast is preferred for diagnosis, though biopsy is sometimes considered. Treatment is usually conservative: rest, glycemic control, and low-dose aspirin. Early recognition is important to avoid unnecessary antibiotics or anticoagulation and to reduce recurrence. One month later, ophthalmology revealed diabetic retinopathy, confirming that she did have previously unrecognized chronic diabetes.

Asset Subtitle

Kain Kim

Meta Tag

Author List Kain Kim, Michael Debakey MD, Nurcan Ilksoy MD

Category Clinical Vignettes

Concept Diabetic Myonecrosis

Concept Diabetes Mellitus

Concept Leg Swelling

Concept Muscle Pain

Concept Magnetic Resonance Imaging

Distinguished Non-Finalist

Presenter Organization Emory University School of Medicine

Presenting Author Kain Kim

Track Adult

Keywords

diabetic myonecrosis

diabetic muscle infarction

thigh pain

muscle swelling

poorly controlled diabetes

hyperglycemia

CT imaging

MRI diagnosis

conservative treatment

diabetic retinopathy

Diabetic Myonecrosis

Diabetes Mellitus

Leg Swelling

Muscle Pain

Magnetic Resonance Imaging