title: Upper extremity diabetic muscle infarction in three patients with end-stage renal disease: a case series and review.
abstract: Diabetic muscle infarction is a rare complication of diabetes. Since first reported in 1965, approximately 130 patients have been reported, with only 2 cases described affecting the upper extremity. We report on 3 men (age, 40-63) with diabetic muscle infarction involving the arm. The patients had symptoms 4 to 18 days before presenting to the emergency department and all required admission for their pain. Only 1 of the patients was febrile. The patients had type 2 diabetes mellitus for 10 to 25+ years, and 2 were on chronic hemodialysis, with the third starting peritoneal dialysis shortly after admission. Hemoglobin A1c ranged from 0.049 to 0.095. Creatine kinase levels ranged from 69 to 483 U/L and the white blood cell count ranged from 9.6 to 12.0 x 10(3)/microL. None of the patients required surgery nor had biopsies, and the patients were managed with rest, transdermal fentanyl, and later physiotherapy. Diagnoses were supported by MRI images in 2 patients and serial ultrasounds in the third patient. Although rare, the condition may be under-recognized. Pathophysiology, which may have some unique features in patients on hemodialysis, is briefly discussed.
authors.affiliation: Division of Rheumatology, Department of Medicine, William Osler Health Care Centre, Ontario, Canada. rjoshi2@gmail.com
authors.forename: Raman
authors.initials: R
authors.lastname: Joshi
authors.forename: Bajinder
authors.initials: B
authors.lastname: Reen
authors.forename: Hilarie
authors.initials: H
authors.lastname: Sheehan
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D006801:Humans; D007238:Infarction / Q000175:diagnosis* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000098:blood supply* / Q000473:pathology; D010530:Peritoneal Dialysis; D034941:Upper Extremity / Q000098:blood supply* / Q000473:pathology