Case 29-1997

Abstract

A 54-year-old woman was admitted to the hospital because of pain and swelling of the right leg.The patient was otherwise in good health except for non-insulin-dependent diabetes mellitus of five years' duration, which was regulated by diet alone. Five years before admission, an endometrioid carcinoma, stage IC, of the right fallopian tube was treated by abdominal hysterectomy with bilateral salpingo-oophorectomy, followed by the administration of cisplatin and cyclophosphamide. Four months before admission, gynecologic and vaginal cytologic examinations and the CA-125 level were normal.One week before admission, the patient awoke with pain in the right calf and tingling in the right foot. On the following day, a Doppler study of the leg at another hospital was normal. The pain worsened and spread to the right thigh and buttock, limiting extension of the knee.Two days before admission, a Doppler study at this hospital was normal. The prothrombin and partial-thromboplastin times were normal, as were the levels of phosphorus, uric acid, bilirubin, magnesium, electrolytes, and amylase. The results of other laboratory tests are shown in Tables 1 and 2. A computed tomographic (CT) scan of the abdomen and pelvis, obtained after the oral and intravenous administration of contrast material, revealed dependent edema in the subcutaneous fat overlying the paraspinal muscles, without evidence of a pelvic mass, retroperitoneal lymphadenopathy, or ascites. Two days later, the patient was admitted to the hospital.The temperature was 37°C, the pulse was 67, and the respirations were 16. The blood pressure was 215/95 mm Hg.On examination the patient was in pain. The right thigh had a maximal circumference of 53 cm, the left thigh 47 cm, and both calves 40 cm. There was tenderness over the distal portion of the posterior right thigh but not in the anterior thigh or calf. The range of motion was full at the right hip and ankle and was 20° to 110° at the right knee. Motor power and sensation were intact in the right leg. The patient was unable to perform straight-leg raising; Homans's sign was absent.

Diabetic muscle infarction and diabetic dermopathy two manifestations of uncontrolled prolong diabetes mellitus presenting with severe leg pain and leg skin lesions

“…The pathogenesis is not clear. The most likely hypothesis is vascular diseases like arteriosclerosis and diabetic microangiopathy [3]. Thigh muscles are the most commonly affected and reports of lower leg involvement are very rare [4].…”

Diabetic myonecrosis in a patient with hepatic cirrhosis: a case report and review of the literature

“…It is related to other complications of diabetes mellitus, such as nephropathy (71%), retinopathy (56%) and neuropathy (54%) [1-3]. Long-term diabetic vasculopathy is essential for developing diabetic myonecrosis [4].…”

“…But before undergoing it, there must be a clear indication, due to the risk of complications. A fine-needle percutaneous biopsy is preferred to open biopsy because of the risk of infection or hematoma [10,3]. Review of the biopsy shows areas of hemorrhagic necrosis and myositis with muscle fibers in different stages of degeneration-regeneration.…”

“…The walls of small vessels are hyalinized with partial or total occlusion of the vessel lumen. In medium-sized vessels, atherosclerosis is observed [4,2,6,3]. Cultures for bacteria, fungi and acid-fast bacilli should be performed, but are negative unless complicated myonecrosis has taken place.…”

Diabetic Neuropathy Part 2

“…74–79 Over a period of days, a firm mass develops in nearly half of cases. The muscles most frequently involved are the vastus lateralis and medialis, thigh adductors, and biceps femoris.…”