Diabetic muscle infarction with complications

Introduction: Diabetic muscle infarction (DMI) is a rare complication of diabetes mellitus (DM) that is often misdiagnosed. We report a case of diabetic muscle infarction and discuss diagnostic testing and treatment modalities to avoid complications. Case Report: A 50­year­old male presented with spontaneous left thigh swelling for five days. He had several previous episodes in the contralateral side with recurrent admissions. His past medical history consisted of poorly controlled type 2 DM on insulin therapy, end stage renal diseases on hemodialysis and hypothyroidism. Physical examination revealed a tight, warm, erythematous and tender left thigh. Laboratory examination showed white blood cell count 1.23x104/μL with neutrophilia; hemoglobin 10.7 g/L, hematocrit 32.3%, alkaline phosphatase 792 U/L, creatinine 5.94 mg/dL and glucose 455 mg/dL. Venous ultrasound of left lower extremity revealed deep vein thrombosis in the mid left femoral vein however, venogram was negative. Compartment syndrome was considered and fasciotomy with biopsy was performed. Subsequently the patient worsened which lead to multiple re­interventions. After reviewing medical records from both our hospital and from other facilities, a diagnosis of DMI was established. Muscle biopsy supported this, revealing active macrophage infiltration with areas of necrosis. Treatment is conservative with pain management, rest and proper glycemic control. Surgical intervention is not necessary as it increases morbidity. Conclusion: Although rare, DMI is a serious and potentially disabling complication of uncontrolled DM which continues to be under­ diagnosed. Recognizing DMI more efficiently could prevent the patient from undergoing numerous, unnecessary diagnostic procedures, and medical or surgical interventions which in turn can result in more harm than good for the patient.