Diabetic muscle infarction (DMI) is a rare complication of long-standing diabetes mellitus. This is the first case of DMI reported by cardiologists. A 49-year-old patient with a history of diabetes and hypertension for only two years was admitted to the cardiac ward due to pain in the left thigh with pitting edema in both lower extremities. Magnetic resonance imaging finally confirmed the presence of DMI in the left thigh, which was improved by treatment with anticoagulants, analgesics and rest. However, the typical clinical symptoms of DMI were unrecognizable at the start of treatment, which may be attributed to a lack of awareness of this rare condition among non-endocrinologist physicians.
Case ReportA 49-year-old Chinese man was admitted to our cardiac ward due to uncontrolled hypertension and lower limb edema, although he complained of acute pain with localized swelling in his left thigh lasting for three days at the clinic visit. Two years prior to admission, he was found to have essential hypertension and type 2 diabetes mellitus, at which time oral medications were initiated. His blood pressure and glucose level were poorly controlled with oral medication for two years, and he had experienced recurrent lower limb edema that was usually diminished with diuretics. Three days earlier, he had felt pitting edema in the lower extremities and pain in the left thigh that restricted him to bed rest at home. He denied any trauma, stinging, fever or chills before the onset of pain.The patient was afebrile. A cardiac examination revealed slight cardiac dullness and normal heart sounds with no murmurs. No wheezes or rales were identified in his lungs. Moderate pitting edema was observed in both lower extremities, although it was more obvious on the left side. A palpable mass measuring 15 cm × 15 cm was found in the middle of the left thigh, which was hard and warm with mild erythema and tenderness. The circumference of the thigh (15 cm above the patella) was 50.1 cm on the left side and 46.1 cm on the right, while the circumference of the leg (15 cm below the patella) was 35.5 cm on the left side and 34.5 cm on the right. However, the popliteal pulse, posterior tibial pulse and dorsalis pedis pulse were strong and symmetrical in both lower limbs.Laboratory tests demonstrated a normal total white blood cell count with a slightly increased neutrophil level of 77.8%, as well as normal liver and renal functions. Neither proteinuria nor microalbuminuria was present. However, both the fasting glucose (9.6 mmol/L) and hemoglobin A1C (7.9%) values were elevated. The levels of creatine kinase (CK) (268 IU/L, reference: 20-140 IU/L), troponin T (34.3 ng/L, reference: <14 ng/L), D-dimer (0.52 mg/L, reference: <0.24 mg/L) and N-terminal pro-B-type natriuretic peptide (2,645 pg/mL, reference: 0-88 pg/mL) were elevated on admission.In addition to the administration of irbesartan and insulin for blood pressure and diabetes control, oral furosemide was given to relieve the patient's symptoms of heart failure, including lowe...
