Muscle infarction in diabetes: clinical manifestations and course

To characterize the initial manifestations and course of muscle infarction in diabetes, a rarely diagnosed condition.

We describe two patients with this disorder and review the clinical characteristics of previously reported cases.

Usually, the initial complaint in patients with muscle infarction in diabetes is swelling of the thigh or calf that has evolved over days to months. Biopsy of the muscle is often necessary for diagnosis and reveals extensive muscle necrosis. Although the pathogenesis is unknown, hypercoagulability may have a role. Bilateral involvement and recurrent disease are common. Treatment is supportive; our patients required narcotics for alleviation of pain.

Muscle infarction in diabetes may mimic thrombophlebitis, soft tissue infection, or a neoplasm. Medical evaluation may be directed toward these entities, and the diagnosis of a diabetes-associated disorder may be completely overlooked. The presence of atraumatic swelling of an extremity in a patient with diabetes should suggest diabetes-related muscle infarction.