Recurrent Diabetic Muscle Infarction Affecting Bilateral Thighs: Uncommon Presentation with Grave Prognosis.

Introduction: Diabetic muscle infarction is a rare microangiopathic complication of poorly-controlled diabetes mellitus. Here we present the case of a female with a thirteen year history of poorly-controlled diabetes mellitus who presented with severe right leg pain and swelling and was eventually diagnosed with this condition.

Case presentation: A 24-year-old female with a thirteen year history of poorly-controlled diabetes mellitus presented with intense right thigh pain and swelling. Initial labs revealed elevated hemoglobin A1c, CK, ESR, and CRP. White blood cell count was within normal limits and patient was afebrile with normal vitals at time of presentation. Magnetic resonance imaging of the right lower extremity demonstrated T1 isohypointensity in the vastus medialis and sartorius with diffuse fascial and subcutaneous edema. Bilateral lower extremity dopplers revealed no evidence of deep vein thrombosis and autoimmune workup was negative. The patient was diagnosed with diabetic muscle infarction given the combination of her clinical presentation and imaging findings. She was started on low-dose aspirin and glycemic control was achieved with a rigorous insulin regimen prior to discharge. She returned six weeks after discharge with persistent right thigh pain and swelling. MRI at this time revealed findings consistent with diabetic muscle infarction in left and right thighs.

Discussion: Clinicians should include diabetic muscle infarction in the differential of any diabetic patient who presents with lower extremity pain and swelling and history of poor glycemic control. Maintaining a high index of suspicion can help confirm the diagnosis early and avoid unnecessary tests and interventions that can lengthen recovery time.