Insights into Diabetes Muscle Infarction: Clinical Characteristics and Outcome.

Abstract

Background: Diabetes muscle infarction (DMI) is a common misdiagnosed and under-reported diabetes complication. This causes a delay in diagnosis, which increases the morbidity of the disease.

Objective: To review all cases of DMI and its pathogenesis, clinical features, prognostic implications, and management.

Methods: We retrospectively analyzed 12 DMI patients diagnosed in the past 15 years. We investigated the disease's clinical characteristics, laboratory results, imaging features, therapies, and prognostic progression.

Result: DMI patients were diagnosed at a mean age of 50 years (range: 33-78 years), were predominantly males (n = 7), and 11 (92%) had type 2 diabetes. They had diabetes for a long time (mean duration 12.6 years). Almost all the patients had nephropathy, neuropathy, or retinopathy. Before presentation, these patients had been symptomatic for an average of 50 days (range: 10-120 days). Most patients presented with unilateral lower limb swelling, local pain and tenderness, and a raised temperature, as well as severe motion-dependent pain. The quadriceps muscle was the most affected, with only one patient experiencing upper limb involvement. On T2W, MRI revealed heterogeneously enlarged muscles with post-contrast enhancement; post-contrast scans revealed multiple focal hypo-enhancing areas, indicating myonecrosis. All the patients were managed conservatively with a good short-term prognosis.

Conclusion: When a patient presents with a painful, tender lump in the lower limb without a history of trauma, DMI should be strongly suspected. MRI findings are diagnostic, and no biopsy is required. Due to multiple comorbidities, these patients are typically managed conservatively, with a good short-term but poor long-term prognosis.