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

Abstract

IntroductionDiabetic myonecrosis was first reported by Angervall and Stener in 1965. In its classical clinical expression, it affects type 1 diabetes mellitus patients with long-standing poor metabolic control and advanced chronic microvascular complications. A sudden-onset of severe pain in the region of the involved muscle, usually the quadriceps, is the typical clinical manifestation. Magnetic resonance imaging (MRI) confirms the clinical diagnosis; in some cases of diagnostic uncertainty, a muscle biopsy may be required.Case PresentationWe present the case of a 38 year-old Hispanic male from Mexico, with alcohol-induced hepatic cirrhosis (Child-Pugh C/MELD 45) and type 2 diabetes mellitus admitted to the emergency room due to hepatic encephalopathy with intense pain and an increase in volume of the left thigh. MRI showed edema and inflammatory changes of the quadriceps muscle with a hyperintense signal on T2-weighted images; in addition, there was a subacute hematoma.ConclusionTo the best of our knowledge, this is the first case of diabetic myonecrosis associated with and complicated by advanced hepatic cirrhosis reported in the literature.

Diabetic Myonecrosis in a Patient with Hepatitis B-Induced Liver Cirrhosis

“…The clinical features of diabetic myonecrosis are nonspecific; therefore, its diagnosis and treatment are often delayed. Although several cases of diabetic myonecrosis occurring in association with other diseases have been reported (2e5), to the best of our knowledge, only 1 case of associated liver cirrhosis has been reported thus far (1). We report here a case of diabetic myonecrosis associated with hepatitis B-induced liver cirrhosis in a young patient with diabetes and review the clinical differences from previously reported cases.…”

“…Diabetic myonecrosis is a rare complication of diabetes mellitus. Only approximately 100 cases have been published (1). The prevalence of various complications increases with the duration of diabetes; thus, this rare complication may be encountered in patients with long-standing diabetes.…”

Recurrent Myonecrosis Involving Adductor Muscle Group Bilaterally: A Rare Complication of Diabetes Mellitus

“…Constitutional symptoms are rare unlike pyomyositis, abscess and cellulitis, which mount toxic responses. [6][7][8] Our patient presented with a thigh swelling without any erythema and induration. There was mild tenderness on deep palpation with no constitutional symptoms.…”

Diabetic Myonecrosis: An Indian Experience

“…The mean age at presentation was 51.5 ± 7.2 years (range 37-56 years), which is higher than noted in a previously published review. 5 The fact that all of our patients had type 2 diabetes may have contributed to the higher mean age.…”

“…This in turn creates a hypercoagulable state. 5,13,14 The coagulation abnormalities associated with cirrhosis may put patients at risk for hematoma formation and infection. Ischemia and associated edema may aggravate the local pressure effect, which may further compromise blood flow to the affected muscles.…”