Myonecrosis Masquerading at an Unusual Site: A Diagnostic Dilemma

Diabetic myonecrosis is a rare complication of diabetes. Thigh and hip muscles are the most common sites while our patient presented with the involvement of calf muscles. The objective of this report is to describe a patient with diabetic myonecrosis of the calf muscles highlighting the need to suspect it at atypical sites also.

A 65-year-old male, a known case of type 2 diabetes which was poorly controlled, presented with subacute onset right calf swelling and pain for 1 month without any history of trauma or fever. On local examination, right calf was swollen, tender, and indurated with a girth difference of around 3 cm as compared with that of the left calf. Ultrasonography was suggestive of marked muscle edema, whereas magnetic resonance imaging was suggestive of myonecrosis in the calf muscles (gastrocnemius and soleus). Muscle biopsy confirmed the diagnosis of myonecrosis. The patient improved with conservative management and a good glycemic control.

Diabetic myonecrosis is a complication of a longstanding uncontrolled diabetes mellitus. This case highlights the fact that though the most common sites of presentation of diabetic myonecrosis are the thigh and the hip muscles but it can present at atypical sites also.

Diabetic myonecrosis is an uncommon but serious complication of diabetes mellitus that requires high clinical suspicion for making the diagnosis. Clinicians should also be vigilant of the atypical sites of presentation and the high chances of recurrence and the long-term mortality seen in such patients.