Endocrine Abstracts

A 64 year old Caucasian man with long standing type 1 diabetes and complications of retinopathy, neuropathy and nephropathy was referred with suspected deep venous thrombosis (DVT) in the left lower limb. He had a week’s history of worsening pain and swelling in the medial left thigh and struggled to weight bear on that leg. He felt unwell a day before admission and was found to have hyperosmolar hyperglycaemic state with ketosis on admission. Ultrasound Doppler was negative for deep venous thrombosis. T2-weighted magnetic resonance imaging (MRI) with gadolinium contrast demonstrated hyper-intense signal in the adductor compartment of the left thigh muscles. He was diagnosed to have diabetic muscle infarction and was managed with analgesia, bed rest, slow intravenous fluids, aspirin and statin. Rigorous glycaemic control was achieved with intravenous insulin. His pain and swelling improved in two weeks and he was discharged home.

Diabetic muscle infarction, also known as diabetic myonecrosis, is a serious but under-diagnosed complication of long standing diabetes. Although most patients recover from the acute episode with conservative management, the recurrence rate is high. Most patients have diabetes related microvascular complications and there is a high rate of mortality and morbidity due to microvascular and macrovascular disease. Timely diagnosis and early involvement of the diabetes team can avoid unnecessary invasive investigations in many cases thereby improving outcomes and shortening hospital stay.