Diabetic Muscle Infarction

Abstract

OBJECTIVE -To systematically review all the reported cases of diabetic muscle infarction (DMI) and its pathogenesis, clinical features, prognostic implications, and management. RESEARCH DESIGN AND METHODS -We searched databases (MEDLINE and EMBASE) from their inception to August 2001 and reviewed bibliographies in reports retrieved.Data were extracted in a standardized form.RESULTS -A total of 47 references were retrieved; 115 patients and 166 episodes were included. DMI was more frequent in women (61.5%, mean age at presentation 42.6 years). Of the cases, 59% had type 1 diabetes; the mean duration of disease was 14.3 years, and multiple diabetic end-organ complications were noted. DMI affects the lower limbs with abrupt onset of pain and local swelling. Diagnosis is made by biopsy, but the characteristic features in magnetic resonance imaging are very typical. Treatment includes bed rest and administration of analgesics, but recurrence is common.CONCLUSIONS -DMI is a very uncommon complication of long-standing diabetes; presentation is well characterized and management is simple. Diabetes Care 26:211-215, 2003S pontaneous aseptic diabetic muscle infarction (DMI) is a rare complication of diabetes. It has been reported as aseptic myonecrosis, ischemic myonecrosis, and tumoriform focal muscular degeneration. Clinical presentation is uniform, with acute onset of painful swelling of the affected muscle and, occasionally, a palpable mass. The differential diagnosis is extensive and DMI is frequently misdiagnosed clinically. The illness is certainly diagnosed by histological biopsy analysis, although the results of T2-weighted magnetic resonance imaging (MRI) may be sufficient to enable other clinical entities to be excluded, thus avoiding inappropriate diagnosis and treatment (1). Although DMI was first reported in 1965 by Angervall and Stener (2) and seems to be a well-characterized complication of diabetes, only a few cases have been published.The goal of this systematic review was to identify the clinical features, pathogenesis, diagnostic aspects, therapeutic management, and prognosis of DMI. RESEARCH DESIGN AND METHODS Questions askedOur review was designed to answer various questions about DMI regarding clinical features, pathogenesis, diagnosis, microscopic and macroscopic appearance, prognosis, and therapeutic aspects. Identification and retrieval of primary studiesWe searched MEDLINE (OVID Technologies and PubMed), EMBASE (OVID Technologies) using the heading "diabetic muscle infarction" and all synonyms and related terms. Databases were searched from their inception to August 2001.Study selection and data extraction Data were systematically extracted from all retrieved reports. Proportions were used in descriptive analysis, and the denominator corresponded to the number of cases in which the investigated characteristic was described. RESULTS Search resultsAfter searching the electronic databases, we identified 47 reference sources (1-47) that included 115 patients with 166 episodes of DMI. The most frequen...

Risking Life and Limb: A Case of Spontaneous Diabetic Muscle Infarction (Diabetic Myonecrosis)

“…Angervail and Stener, the pathophysiology and epidemiology remain largely unknown. 1 A systematic review in 2006 found 115 cases reported in the literature, but the actual incidence of diabetic muscle infarction is thought to be significantly higher. 2 This review also suggested that diabetic muscle infarction occurs more frequently in middle-aged individuals (mean age of 43) and has a female predilection.…”

“…1 Diabetic muscle infarction typically presents as suddenonset unilateral lower limb pain, most often in the thigh, although there may be bilateral involvement in approximately 30 % of cases. 2 Patients also frequently describe a mass-like area of induration in the affected limb.…”

Diabetic Myonecrosis Mimicking Acute Compartment Syndrome of the Thigh

“…It affects both type 1 and type 2 diabetic patients, is usually self-limiting and responds well to conservative management [1][2][3][4]. It commonly affects the lower limb with thigh muscles being most commonly involved [1,3].…”

“…It commonly affects the lower limb with thigh muscles being most commonly involved [1,3]. The disease commonly affects women (61.5% of all cases), type 1 diabetes patients (59% of all cases) and patients with long-standing diabetes (mean duration of disease 14.3 years) [2]. Although it most commonly involves a single limb, bilateral involvement has been described in 8.4%of cases [2].…”

“…The disease commonly affects women (61.5% of all cases), type 1 diabetes patients (59% of all cases) and patients with long-standing diabetes (mean duration of disease 14.3 years) [2]. Although it most commonly involves a single limb, bilateral involvement has been described in 8.4%of cases [2]. Since the condition presents with characteristic symptoms of compartment syndrome [1][2][3], it can easily be misdiagnosed and treated surgically.…”