Insights into Diabetes Muscle Infarction: Clinical Characteristics and Outcome

Diabetes muscle infarction (DMI) is a common misdiagnosed and under-reported diabetes complication. This causes a delay in diagnosis, which increases the morbidity of the disease.

To review all cases of DMI and its pathogenesis, clinical features, prognostic implications, and management.

We retrospectively analyzed 12 DMI patients diagnosed in the past 15 years. We investigated the disease's clinical characteristics, laboratory results, imaging features, therapies, and prognostic progression.

DMI patients were diagnosed at a mean age of 50 years (range: 33-78 years), were predominantly males (n = 7), and 11 (92%) had type 2 diabetes. They had diabetes for a long time (mean duration 12.6 years). Almost all the patients had nephropathy, neuropathy, or retinopathy. Before presentation, these patients had been symptomatic for an average of 50 days (range: 10-120 days). Most patients presented with unilateral lower limb swelling, local pain and tenderness, and a raised temperature, as well as severe motion-dependent pain. The quadriceps muscle was the most affected, with only one patient experiencing upper limb involvement. On T2W, MRI revealed heterogeneously enlarged muscles with post-contrast enhancement; post-contrast scans revealed multiple focal hypo-enhancing areas, indicating myonecrosis. All the patients were managed conservatively with a good short-term prognosis.

When a patient presents with a painful, tender lump in the lower limb without a history of trauma, DMI should be strongly suspected. MRI findings are diagnostic, and no biopsy is required. Due to multiple comorbidities, these patients are typically managed conservatively, with a good short-term but poor long-term prognosis.