I Walther1, B Vande Berg, T-M Lejeune. 1. Service de médecine physique et réadaptation, cliniques universitaires Saint-Luc, université catholique de Louvain, 10, avenue Hippocrate, 1200 Bruxelles, Belgique.
Abstract
INTRODUCTION: Several neuromuscular diseases may complicate diabetes mellitus and transplantation, including chronic sensorimotor length dependent polyneuropathy. OBJECTIVE: Description of muscular infarction, a rare complication of diabetes mellitus, which occurred after liver and kidney transplantation. CASE REPORT: A 57-year-old patient presented with long-term diabetes mellitus and multiple complications. End-stage renal and hepatic disease led to kidney and liver transplantation. Twenty-seven days after transplantation, swelling and induration appeared in the left shoulder and forearm. Forty-three days after transplantation, the same symptoms appeared in both lower limbs. Markedly reduced range of motion led to severe disability. Bone scans showed multiple spots following muscle anatomy. Computed tomography gave negative results. Magnetic resonance imaging (MRI) confirmed muscular infarction by a high T1 signal (muscular necrosis) and soft-tissue infiltration. DISCUSSION AND CONCLUSION: Muscular infarction is a rare and unknown complication of diabetes mellitus. It is characterised by sudden painful muscular induration and swelling affecting one muscle at a time with recurrence. Our patient presented with simultaneous multiple muscular infarctions in 3 limbs. Diagnosis was based on clinical investigation and MRI. The treatment is conservative and the condition generally resolved by itself. However, the long-term prognosis of muscular infarction is not good because of the cardiovascular-associated complications of diabetes mellitus.
INTRODUCTION: Several neuromuscular diseases may complicate diabetes mellitus and transplantation, including chronic sensorimotor length dependent polyneuropathy. OBJECTIVE: Description of muscular infarction, a rare complication of diabetes mellitus, which occurred after liver and kidney transplantation. CASE REPORT: A 57-year-old patient presented with long-term diabetes mellitus and multiple complications. End-stage renal and hepatic disease led to kidney and liver transplantation. Twenty-seven days after transplantation, swelling and induration appeared in the left shoulder and forearm. Forty-three days after transplantation, the same symptoms appeared in both lower limbs. Markedly reduced range of motion led to severe disability. Bone scans showed multiple spots following muscle anatomy. Computed tomography gave negative results. Magnetic resonance imaging (MRI) confirmed muscular infarction by a high T1 signal (muscular necrosis) and soft-tissue infiltration. DISCUSSION AND CONCLUSION:Muscular infarction is a rare and unknown complication of diabetes mellitus. It is characterised by sudden painful muscular induration and swelling affecting one muscle at a time with recurrence. Our patient presented with simultaneous multiple muscular infarctions in 3 limbs. Diagnosis was based on clinical investigation and MRI. The treatment is conservative and the condition generally resolved by itself. However, the long-term prognosis of muscular infarction is not good because of the cardiovascular-associated complications of diabetes mellitus.