Diabetic myonecrosis: A rare complication of long-standing diabetes mellitus

Diabetes mellitus is a rapidly growing health illness worldwide and its incidence is expected to continue rising. Various complications have been cited including retinopathy, nephropathy, peripheral artery disease and ulceration among others. However, rarer complications such as diabetic myonecrosis are limited in literature. This case report demonstrates the presentation of this complication to allow for earlier detection and treatment by providers.

This case highlights a 49-year-old man with an extensive past medical history inclusive of diabetes mellitus type 2, who presented with acute onset left thigh pain and swelling. On presentation, the patient has an HbA1c of 8 % and hyperpigmented spots were noted bilaterally on the lower extremities. Initial management was centered around infectious etiologies and management which failed to improve his symptoms. Further work-up included a negative lower extremity duplex ultrasound and a CT scan showing a hypodense lesion in the left lower extremity. Following unsuccessful drainage of the lesion to assess for a possible abscess, MRI of the lower extremities showed bilateral myositis and myonecrosis centered in the left vastus medialis.

This case report highlights a rare complication of diabetes mellitus known as diabetic myonecrosis (DMN). The gold-standard diagnostic tool is a muscle biopsy, however, sensitive imaging like MRI and clinical context are sufficient for a diagnosis. Supportive care centered around pain management remains the standard of care. While this remains as a diagnosis of exclusion, early identification may decrease the number of unnecessary treatments and should remain as a differential in patients with this presentation.