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Diabetic Myonecrosis ,a diagnosis delima  


Abstract Category: Science
Course / Degree: Case Report
Institution / University: Montefiore Medical Center, United States
Published in: 2013


Report Abstract / Summary:

Background:

Diabetic myonecrosis, a known but unusual entity, is a difficult diagnosis to make in a patient presenting with severe pain in the leg. We report a case of diabetic myonecrosis with a complicated hospital course.

Case:

A 19 year old male with a Type 1 DM on insulin pump, presented to the emergency department with worsening redness and painful swelling of the left leg despite taking ibuprofen and oral clindamycin. He denied trauma or insect bites.

In the ED, vital signs were as follows: Temp: 101.2OF, pulse: 144/min BP: 170/76 mmHg.

He had firm swelling of his left anterolateral leg with a 10 x 12 cm area of induration, warmth, erythema and tenderness and palpable pulses. His leucocyte count was 11800/uL with 79% neutrophils, ESR 35, CPK 10769 and HbA1C 10.3%. Venous Doppler ruled out DVT.

He was started on analgesics and IV antibiotics for cellulitis. He developed DKA and compartment syndrome and was transferred to the ICU. CT and MRI revealed signal changes in the left anterior tibialis muscle with diffuse edema. Urgent surgery and fasciotomy were performed; a large fluid collection between infarcted muscles was found, without purulence. The tibialis anterior and extensor hallucis longus muscles were infarcted and necrosed and required partial resection. Pathology revealed acute and chronic inflammation with focal necrosis. Blood cultures, aerobic and anaerobic cultures of the fluid were negative. He was treated with bed rest, intravenous antibiotics, fluids, hyperbaric oxygen and analgesics. He was discharged with improvement of pain and mobility and normalization of his CPK and WBC.

Discussion:

Diabetic myonecrosis, an infrequent complication of DM, typically occurs in the thigh and calf muscles. Patients present with severe pain and swelling in the leg, elevated ESR and muscle enzymes.

The differential diagnosis includes cellulitis, pyomyositis, necrotizing fasciitis, and diabetic myonecrosis. Although diabetic myonecrosis is suspected because of the absence of pus and repeatedly negative cultures, the fever and leucocytosis suggest the presence of infection. Our patient was treated for both diabetic myonecrosis and suppurative myonecrosis.

Conclusion:

Diabetic myonecrosis should be considered in the differential diagnosis of a diabetic patient who presents with pain and swelling of the lower extremities and elevated CPK.

Collaboration between Medicine and Surgery is urgently needed for management of this rare entity.


Report Keywords/Search Tags:
diabetes melitus,myonecrosis

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Submission Details: Report Abstract submitted by kourosh moshiri from United States on 20-May-2014 23:57.
Abstract has been viewed 2175 times (since 7 Mar 2010).

kourosh moshiri Contact Details: Email: drkmoshiri@yahoo.com



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