An unexpected cause of muscle pain in diabetes

Silberstein, L; Britton, K. E.; Marsh, Frank; Raftery, Martin; D’Cruz, David

doi:10.1136/ard.60.4.310

Cited by 54 publications

(35 citation statements)

References 29 publications

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“…3,4,[7][8][9] In diabetic patients, the well-known vascular changes-such as microangiopathy, atheroma embolization, or vascular occlusion with consequent muscle edema, which reduces capillary blood flow-may contribute to muscle injury. 9 One case series reported that idiopathic rhabdomyolysis often occurs in patients with liver cirrhosis and suggested that defective muscle metabolism due to hepatic dysfunction results in rhabdomyolysis in these patients. 8 Acute and chronic alcohol intoxication also has direct toxicity to muscle.…”

Section: Discussionmentioning

confidence: 99%

“…10,13 It has also been reported that the CPK levels were normal or mildly elevated in patients with diabetic muscle infarction. 9 Moreover, the diagnosis can also be made by plasma measurement of myoglobin levels even without measurement of CPK levels, 14 and some authors reported a case of rhabdomyolysis without describing the CPK levels. 15 We could not find evidence in the literature that CPK levels are always elevated in rhabdomyolysis cases.…”

Section: Discussionmentioning

confidence: 99%

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Rhabdomyolysis During Laparoscopic Hepatic Subsegmentectomy

Park

Jee

2014

CRSLS

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rhabdomyolysis During Laparoscopic Hepatic Subsegmentectomy

Park

Jee

2014

CRSLS

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“…The onset is usually acute, and spontaneously resolves after several weeks to months. 3 Recurrent episodes of muscle infarction in the same or a contralateral limb are reported to occur in half of patients, some of whom may have multiple recurrences. 4,5 The second patient developed a second attack nine years after the first in the same group of muscles.…”

Section: Discussionmentioning

confidence: 99%

“…Since then, considerable experience has accumulated through case reports and review of previously published cases. [2][3][4][5][6][7][8][9][10][11][12][13][14] Diabetic muscle infarction is a distinct entity with characteristic clinical and radiological findings. It is probably more common than previously recognized.…”

Section: Discussionmentioning

confidence: 99%

Diabetic Muscle Infarction – An Often Missed Complication

2003

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M Hammoudeh, I Khanjar, S Mehdi, Diabetic Muscle Infarction -an Often Missed Complication. 2003; 23(6): 394-396 Diabetic muscle infarction (DMI), or myonecrosis, is an uncommon and often missed complication of diabetes. It occurs in both types of diabetes, but more often in type 1 and appears to be attributable to microangiopathy. It has a characteristic clinical presentation, including acute onset of painful swelling most commonly in the thigh or calf muscles in the absence of systemic manifestation. It is frequently misdiagnosed clinically as neoplasm, abscess, focal myositis, or deep vein thrombosis. Magnetic resonance imaging (MRI) is extremely helpful in making the diagnosis and excluding other possibilities. It usually improves gradually to complete resolution within weeks to a few months. The two cases described emphasize the importance of early recognition and diagnosis of this complication to avoid an unnecessary intervention or hazardous treatment. CaseCase 1. A 62-year-old female patient presented with a three-day history of pain and swelling of the left leg, which had gradually increased over the last 24 hours prior to admission. There was no history of trauma, fever or previous history of similar episodes. She had had diabetes mellitus type 2 for 22 years and had been on insulin therapy for the last 5 years. She also had had hypertension for 4 years and had developed diabetic nephropathy 2 years ago. On physical examination the left calf muscle was swollen and tender, but the foot was neither swollen nor tender. A presumptive diagnosis of deep vein thrombosis (DVT) was made and she was treated with heparin. Laboratory investigation revealed WBCs of 10,700/ mm 3 with 85% granulocytes, creatinine 2.4 mg/dL, and creatinine kinase 340 IU/L (normal up to 170 IU/ L). Doppler ultrasound of the calf, done on the next day, showed edema of the gastrocnemius muscle with no evidence of DVT. Arterial Doppler study showed significant obstruction of the anterior tibial artery. MRI of the legs (Figure 1) showed swelling and high signal intensity in T2-weighted images in the left gastrocnemius and soleus muscles with subcutaneous edema. A diagnosis of DMI was made. Heparin was replaced by analgesics and the patient was advised to rest in bed. The swelling subsided significantly within 4 weeks and almost returned to normal after 8 weeks with disappearance of the pain.

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“…It can be triggered by an ischemic event and causes extensive muscle necrosis through hypoxia-reperfusion injury and compartment syndrome [2]. Angervall and Stener [3] first described muscle infarction in diabetic patients in 1965.…”

Section: Introductionmentioning

confidence: 99%

Diabetic Muscle Infraction: An Unusual Cause of Muscle Pain in a Diabetic Patient on Hemodialysis

et al. 2005

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Diabetic muscle infarction (DMI) is a rare, painful and potentially serious complication in patients with poorly controlled diabetes mellitus and frequently misdiagnosed clinically as abscess, neoplasm, or myositis. A 36-year-old diabetic woman referred to our clinic with severe pain in the left antero-medial thigh. She had a 15-year history of Type 2 diabetes mellitus (DM). She was complicated by diabetic nephropathy and requiring hemodialysis. She had first noticed pain and swelling in her left thigh after a minimal trauma for 2 days prior to presentation. Clinical and laboratory evaluation, and muscle biopsy revealed the diagnosis of muscle infarctions. She did no respond to the conservative therapy. Pain and swelling in her thigh worsened progressively. She underwent surgical debridment and then, her clinical status improved. We describe the characteristic clinical and pathologic findings and the course of the illness with emphasis on the importance of recognition of the syndrome so that unnecessary investigation and overzealous therapy can be avoided.

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An unexpected cause of muscle pain in diabetes

Cited by 54 publications

References 29 publications

Rhabdomyolysis During Laparoscopic Hepatic Subsegmentectomy

Rhabdomyolysis During Laparoscopic Hepatic Subsegmentectomy

Diabetic Muscle Infarction – An Often Missed Complication

Diabetic Muscle Infraction: An Unusual Cause of Muscle Pain in a Diabetic Patient on Hemodialysis

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