Myonecrosis complicating uncontrolled diabetes mellitus

Area of Science:

• Endocrinology
• Radiology
• Musculoskeletal Diseases

Background:

• Diabetic myonecrosis is a rare, often underdiagnosed, complication of diabetes mellitus.
• It typically presents with acute muscle pain and swelling, mimicking other conditions.
• Diagnosis can be challenging, with tissue biopsy being the gold standard.

Observation:

• A 37-year-old woman with type 1 diabetes and end-stage renal disease presented with severe left thigh pain, warmth, swelling, and tenderness.
• Magnetic resonance imaging (MRI) revealed extensive soft tissue edema and a fluid collection in the adductor magnus muscle.
• Needle aspiration confirmed hematoma and myonecrosis; cultures and cytology were negative.

Findings:

• The patient was diagnosed with diabetic myonecrosis based on clinical presentation and imaging findings.
• MRI demonstrated characteristic signs of myonecrosis, including edema and a fluid collection.
• While biopsy is definitive, MRI showed high sensitivity and specificity in this case.

Implications:

• Prompt diagnosis of diabetic myonecrosis is crucial to prevent further muscle damage and morbidity.
• Non-contrast MRI can be a valuable tool for diagnosing diabetic myonecrosis, potentially avoiding invasive procedures.
• This case highlights the importance of considering rare diabetic complications in patients with poorly controlled diabetes.