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Skeletal muscle infarction in diabetes mellitus
E Grigoriadis1, A G Fam, M Starok
1Department of Medicine, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.
The Journal of Rheumatology
|April 27, 2000
Summary
Diabetic muscle infarction (DMI) is a rare complication in patients with long-standing, poorly controlled diabetes mellitus. Early recognition is key, with MRI being the preferred diagnostic tool.
Area of Science:
- Endocrinology
- Neurology
- Radiology
Background:
- Diabetic muscle infarction (DMI) is a rare, yet serious complication of diabetes mellitus (DM).
- Understanding its risk factors, clinical presentation, and diagnostic methods is crucial for timely intervention.
Observation:
- This study analyzed 52 cases of DMI, including 3 new cases and 49 from literature review.
- Typical patient profile: middle-aged (mean 41.5 yrs), with long-standing (mean 15.2 yrs), poorly controlled DM, often type 1, and microvascular complications.
- Common symptoms include painful, diffuse muscle swelling, particularly in the quadriceps, with elevated creatine phosphokinase levels.
Findings:
- DMI is strongly associated with poor glycemic control and microvascular complications (neuropathy, retinopathy, nephropathy).
- Magnetic Resonance Imaging (MRI) demonstrated 100% diagnostic accuracy for DMI, showing characteristic muscle infarct findings.
- Histopathology confirmed muscle infarction, with one case showing microangiopathy on ultrastructural analysis.
Implications:
- Increased clinical suspicion for DMI is vital in diabetic patients presenting with acute limb pain and swelling.
- MRI is the diagnostic modality of choice, potentially avoiding the need for muscle biopsy.
- DMI, though often self-resolving, has a high recurrence rate, necessitating ongoing management of diabetes control.