Endocrine Abstracts

Introduction: Diabetic muscle infarction (DMI) is a rare complication of long-standing, poorly controlled diabetes, and it’s more common in patients with micro-vascular complications. Herein, we present a case of DMI occurring in patient on hemodialysis.

Case presentation: A 44-year-old man on maintenance hemodialysis presented with an acutely painful and swelling in his left calf. He had a 21-year history of poorly controlled type one diabetes, with micro-vascular complications (nephropathy and retinopathy). On physical examination: his skin was pale, his temperature was 37°c, his heart rate was 80 beats per minute and his blood pressure was 150/80 mmHg. His left calf was swollen and tender with no edema or inflammatory signs. Biochemical findings showed: C-reactive protein (CRP) 42 mg/l, CPK 179 U/l (39-308) and LDH 382 U/l (140-280). A Doppler ultrasound showed no sign of deep vein thrombosis, but demonstrated edema of the superficial tissues which prompted the practice of an MRI showing thickening of the lateral gastrocnemius muscle with edema. It is the seat of a lack of enhancement extending over 3 cm with the interposition of a few fibers of marked enhancement. The thickening and muscle edema was more important in the posterior compartment of the leg. It also showed edematous infiltration of fascia and subcutaneous cellulitis without significant enhancement and minimal fatty degeneration of the different muscle compartments of the leg. The patient was put on analgesics and activity restriction in the acute phase followed by gradual mobilization.

Conclusion: Diabetic muscle infarction is a rare and under-reported condition that should be suspected in any diabetic dialysis patient who develops a painful, swollen muscle.