Myonecrosis complicating uncontrolled diabetes mellitus

A 37-year-old woman with uncontrolled type 1 diabetes mellitus and end-stage renal disease presented to our hospital with 10 days of severe left thigh pain. Physical examination revealed warmth, swelling, and tenderness of the left anterior and medial thigh. Workup revealed a mildly elevated creatinine kinase. Magnetic resonance imaging without contrast revealed diffuse extensive soft tissue edema and a heterogeneous, tubular fluid collection within the adductor magnus. Needle aspiration revealed hematoma and myonecrosis. Cultures and cytology were negative. A diagnosis of diabetic myonecrosis was made. Myonecrosis is a rare complication of diabetes, and the gold standard for diagnosis is tissue biopsy. However, magnetic resonance imaging may be sensitive and specific for diagnosis and prevent morbidity.