help button home button Endocrine Society JCEM
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text (PDF)
Right arrow Submit a related Letter to the Editor
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Copyright Permission
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hoyt, J. R.
Right arrow Articles by Wittich, C. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hoyt, J. R.
Right arrow Articles by Wittich, C. M.
Related Collections
Right arrow Diabetes and Insulin
The Journal of Clinical Endocrinology & Metabolism Vol. 93, No. 10 3690
Copyright © 2008 by The Endocrine Society

IMAGE IN ENDOCRINOLOGY

Diabetic Myonecrosis

John R. Hoyt and Christopher M. Wittich

Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905

Address all correspondence and requests for reprints to: Christopher M. Wittich, M.D., Pharm.D., Department of Medicine, Division of General Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. E-mail: Wittich.Christopher{at}mayo.edu.

A 40-yr-old woman with type I diabetes mellitus and diabetic nephropathy, retinopathy, and neuropathy presented with a 7-month history of left leg pain with no antecedent trauma.

Physical examination revealed enlargement and tenderness over the anterior and lateral aspect of the left thigh. Pulses, venous ultrasound, and arterial Doppler were normal. Laboratory tests revealed a mild leukocytosis of 11.0 x 10(9)/liter and normal creatine kinase.

Magnetic resonance imaging (MRI) showed extensive edema in the anterior and lateral aspect of the left thigh, localizing to the vastus intermedius and medialis muscles, associated with an area of hemorrhagic myonecrosis (Fig. 1Go).


Figure 1
View larger version (73K):
[in this window]
[in a new window]

  		FIG. 1. T2 weighted MRI showing extensive edema of vastus lateralis and vastus medialis (thin arrows), 1.8- x 2.5-cm of hemorrhagic myonecrosis (thick arrow), and femur (curved arrow).

 
Diabetic myonecrosis (DM) is a rare complication of diabetes first described in 1965 by Angarwall and Stener (4). Most patients have poorly controlled diabetes and present with acute pain (80%) and swelling (75.9%), often localized to the thigh (83.7%) (1). Pathogenesis may involve hypoxia-reperfusion injury, atherosclerotic occlusion, or vasculitis with thrombosis (2).

DM is often initially unrecognized, leading to delayed diagnosis and patient suffering (3). The differential diagnosis includes tumor, thrombus, and infection. MRI shows increased signal within the muscle and can detect tumor. Biopsy with cultures and ultrasound can determine whether infection or thrombus are present, respectively.

Treatment for DM is control of diabetes and pain. Most patients die within 5 yr of diagnosis (3). In summary, DM should be considered when a diabetic patient presents with severe muscular pain.


   Footnotes
 
Disclosure Summary: The authors have nothing to declare or disclose.

Abbreviations: DM, Diabetic myonecrosis; MRI, magnetic resonance imaging.

Received February 26, 2008.

Accepted July 2, 2008.


   References
Top
 References
 

  1. Trujillo-Santos AJ 2003 Diabetic muscle infarction. Diabetes Care 26:211–215[Abstract/Free Full Text]
  2. Habib G, Nashashibi M, Walid S 2003 Diabetic muscular infarction: emphasis on pathogenesis. Clin Rheumatol 22:450–451[CrossRef][Medline]
  3. Wintz RL, Pimstone KR, Nelson SD 2006 Detection of diabetic myonecrosis: complication is often-missed sign of underlying disease. Postgrad Med 119:66–69[Medline]
  4. Angerall L, Stener B 1965 Tumoriform focal muscular degeneration in two diabetic patients. Diabetologia 1:39–42[CrossRef]




This Article
Right arrow Full Text (PDF)
Right arrow Submit a related Letter to the Editor
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Copyright Permission
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hoyt, J. R.
Right arrow Articles by Wittich, C. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hoyt, J. R.
Right arrow Articles by Wittich, C. M.
Related Collections
Right arrow Diabetes and Insulin

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Endocrinology Endocrine Reviews J. Clin. End. & Metab.
Molecular Endocrinology Recent Prog. Horm. Res. All Endocrine Journals