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

Abstract

Diabetic muscular infarction (DMI) is a rare manifestation which can be seen in patients with long-standing diabetes mellitus. Patients usually come with painful swelling of an involved muscle in one extremity. MRI and biopsy histology can help diagnose this condition. Diabetic dermopathy is another manifestation of patients with diabetes.We present a patient with uncontrolled diabetes type 2 presented with pain, swelling, and a palpable tender mass in one leg along with new skin lesions. Biopsy of the skin lesion and T2-weighted MRI of the leg helped differentiate DMI and dermopathy.

Diabetic Muscle Infarction: A Rare End-Organ Vascular Complication of Diabetes

“…1,2,5,7,[9][10][11]15,18 The severe pain, even at rest, was exacerbated by movement, which limited her mobility. 8,11,12,14,17,19,20 DMI usually presents unilaterally 4,10,18 in the proximal lower extremity (81-83%) with rare reports of distal leg involvement. 2,5,8,11,14,19,20 Muscles commonly affected include quadriceps (60%), 4,10,16,18 hip adductors (13%), 4,10,11,14,16 hamstrings (8%) 4,10,16,18 and hip flexors (2%).…”

“…8,11,12,14,17,19,20 DMI usually presents unilaterally 4,10,18 in the proximal lower extremity (81-83%) with rare reports of distal leg involvement. 2,5,8,11,14,19,20 Muscles commonly affected include quadriceps (60%), 4,10,16,18 hip adductors (13%), 4,10,11,14,16 hamstrings (8%) 4,10,16,18 and hip flexors (2%). 4,10,16 Patients are typically afebrile, without skin discoloration, 9,11,20 and usually present with accompanying local swelling (90%-99%), 1,2,4,5,7-13,16-20 tenderness, 1,2,[4][5][6][7][8][9][10]12,13,[15][16]…”

“…2,5,8,11,14,19,20 Muscles commonly affected include quadriceps (60%), 4,10,16,18 hip adductors (13%), 4,10,11,14,16 hamstrings (8%) 4,10,16,18 and hip flexors (2%). 4,10,16 Patients are typically afebrile, without skin discoloration, 9,11,20 and usually present with accompanying local swelling (90%-99%), 1,2,4,5,7-13,16-20 tenderness, 1,2,[4][5][6][7][8][9][10]12,13,[15][16][17][18][19] and painful, palpable mass (44%). 2,6,7,9,[11][12][13][14]…”

“…4,10,16 Patients are typically afebrile, without skin discoloration, 9,11,20 and usually present with accompanying local swelling (90%-99%), 1,2,4,5,7-13,16-20 tenderness, 1,2,[4][5][6][7][8][9][10]12,13,[15][16][17][18][19] and painful, palpable mass (44%). 2,6,7,9,[11][12][13][14][17][18][19][20] DMI is frequently misdiagnosed because of the significant overlap of its clinical features with other life-and limb-threatening etiologies, and there remains no clear consensus of diagnostic criteria. 1,6,15 Differential diagnoses considerations are extensive (Table 2).…”

“…Currently, diagnosis of DMI consists of a clinical assessment and MRI. [5][6][7]19 Muscle biopsies, revealing some combination of monocytic inflammation, hemorrhagic necrosis, fibrosis, atrophy, and neovascularization, are the gold standard, carrying 90% sensitivity and 95% sensitivity 19 , and are not recommended because of procedural complications, including delayed healing and infection. 1,2,[4][5][6][7]10,15,16,19 If attempted, a minimally invasive approach is recommended, which should be reserved for patients with an atypical presentation, uncertain diagnosis, or those that do not improve with treatment.…”