A rare, unusually acute presentation of denervation pseudohypertrophy

Denervation pseudohypertrophy is an important and well described, albeit rare, cause of limb swelling that is seldom encountered in the clinical setting. Careful history taking, reasonable clinical suspicion, and referral for magnetic resonance imaging are crucial to arriving at the diagnosis and recommending appropriate treatment. Although typically a slow, insidious process, we report a rare case of acute denervation pseudohypertrophy in a 76-year-old male with diabetic neuropathy, chronic venous insufficiency, and remote tibial fracture repair. Magnetic resonance imaging findings were significant for bilateral denervation pseudohypertrophy of the left greater than right calf muscles with associated diabetic neuropathy. We postulated that the latter is likely the main underlying etiology, particularly given the magnetic resonance imaging's bilateral findings. The case highlights the importance of considering denervation pseudohypertrophy in the differential diagnosis of acute limb swelling despite its rarity.