Diabetic myonecrosis: challenges in diagnosis and management

IF 0.4 Q4 ENDOCRINOLOGY & METABOLISM
Kanyada Koysombat, Sarra Elmustafa, Hardi Madani, Felicity Kaplan
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Abstract

Case presentation A 29-year-old female presented with acute onset right thigh pain and swelling 24 hours after peritoneal dialysis catheter insertion. She had a background of type 1 diabetes mellitus diagnosed over 20 years prior to presentation. Her glycaemic control had been suboptimal, with multiple episodes of diabetic ketoacidosis and complications including diabetic retinopathy, gastroparesis, autonomic neuropathy and end stage renal disease secondary to diabetic nephropathy, requiring peritoneal dialysis. She was discharged after completing a course of intravenous antibiotics for presumed infection but re-presented one week later to her renal team with worsening right thigh pain and swelling. There was no history of trauma or symptoms to suggest an infective aetiology. On examination she was in severe pain. She was tachycardic with a pulse rate of 110 bpm, blood pressure was elevated at 158/90 mmHg, she was afebrile and had normal oxygen saturation levels. The peritoneal catheter site appeared clean and her abdomen was soft with no ascites. The right thigh was markedly enlarged, circumference 45 cm compared with 25 cm on the left (Figure 1), very tender and warm to touch and movement limited due to pain. There was no erythema or inguinal lymphadenopathy and peripheral pulses were easily palpable.
糖尿病性肌坏死:诊断和治疗的挑战
病例介绍一名29岁女性,在插入腹膜透析导管24小时后出现急性右大腿疼痛和肿胀。患者在发病前20多年诊断为1型糖尿病。她的血糖控制欠佳,多次发作糖尿病酮症酸中毒,并发症包括糖尿病视网膜病变、胃轻瘫、自主神经病变和继发于糖尿病肾病的终末期肾病,需要腹膜透析。患者在完成一个疗程的静脉抗生素治疗后出院,但一周后因右大腿疼痛和肿胀加重再次出现在肾科。没有外伤史或感染病因的症状。经检查,她感到剧痛。她心跳过速,脉搏110bpm,血压升高至158/ 90mmhg,她不发热,血氧饱和度正常。腹膜导管部位干净,腹部柔软,无腹水。右大腿明显增大,周长为45厘米,而左大腿周长为25厘米(图1),摸起来非常柔软和温暖,由于疼痛而活动受限。无红斑或腹股沟淋巴结病变,外周脉搏易触及。
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来源期刊
British Journal of Diabetes
British Journal of Diabetes ENDOCRINOLOGY & METABOLISM-
自引率
16.70%
发文量
15
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