Diabetic Muscle Infarction (Myonecrosis): Underdiagnosed or Underreported?

Diabetic muscle infarction is a rare complication of diabetes. It is seen more in Type 1 DM than Type 2 DM, but in both it is associated with longer duration of diabetes, poor glycemic control with or without microvascular complications. We present a case report of a 47 year diabetic male, who presented with sudden onset of painful swelling of the left thigh muscles (vastus group). The patient had microvascular complications of diabetes. Apart for mild elevation of CPK and LDH other investigations were normal. MRI findings of left thigh showed T2 hyperintensities in the involved muscles which established the diagnosis. Muscle biopsy revealed necrosis of the muscle fibres, presence of inflammatory cell infiltrates and hyalinization of the blood vessels with luminal narrowing which is characteristic of diabetic muscle infarction. The patient was treated with immobilization, analgesics and adequate blood sugar control. This case highlights the rarity of finding vascular changes as well as the poor prognosis and the occurrence of fatal complications in near future.