Spontaneous diabetic myonecrosis: report of four cases from a tertiary care institute

Summary

Spontaneous diabetic muscle infarction (DMI) is a rare and under diagnosed complication of diabetes mellitus. Clinically it presents with acute to subacute onset swelling, pain and tenderness of muscle(s) without systemic manifestations. MRI is helpful in diagnosis, exclusion of other causes and for localization of affected muscle for biopsy in atypical cases. Muscles of the thighs are commonly affected in diabetic myonecrosis (DMN). Here we present the summary of four cases seen in the last 3 years in a tertiary care centre with simultaneous or sequential involvement of multiple groups of muscles or involvement of uncommon sites. All these patients had advanced duration of diabetes with microvascular complications and poor glycemic control. Conservative management including rest and analgesics is the treatment of choice. Short-term prognosis is good but there may be recurrence.

Learning points

• A high index of suspicion is required for the diagnosis of DMN which can avoid inadvertent use of antibiotics.

• Acute–subacute onset severe focal muscle pain in the absence of systemic symptoms in a female patient with long-standing diabetes with microvascular complications suggests DMI.

• MRI is the most sensitive test for diagnosis.

• Muscle biopsy should be reserved for atypical cases.

• Conservative management including rest and analgesics has good outcome.

• Improvement usually occurs within 6–8 weeks, but there may be recurrence.