title: Diabetic Myonecrosis: A Rare Complication of Diabetes Mellitus Mimicking Deep Vein Thrombosis.
abstract: BACKGROUND Diabetic myonecrosis is an uncommon complication of long-standing poorly controlled diabetes mellitus. It presents as acute non-traumatic swelling and pain of the lower extremity, which can mimic deep vein thrombosis (DVT). The clinical course is usually self-limiting and patients respond well to supportive medical therapy. CASE REPORT A 54-year-old male with past medical history of poorly controlled diabetes mellitus type II, hyperlipidemia, gastroesophageal reflux disease (GERD), and remote history of DVT presented to our emergency department with 2-week history of progressively worsening left calf pain and swelling. On physical examination, the patient had increased warmth, edema, erythema, and tenderness in the left calf, with positive Homan's sign. A lower-extremity venous Doppler was negative for DVT. His creatinine phosphokinase (CPK) level was normal, but hemoglobin A1C was 11.0%, reflective of poor glycemic control. Magnetic resonance imaging (MRI) of the left calf revealed a focus of non-enhancement in the gastrocnemius muscle along with increased enhancement of the rest of the muscle, suggestive of diabetic myonecrosis. CONCLUSIONS Diabetic myonecrosis is a rare complication of long-standing diabetes mellitus that can often mimic DVT. Diagnosis can be made on an MRI, and treatment involves strict glycemic control along with antiplatelet therapy and non-steroidal anti-inflammatories (NSAIDs).
authors.affiliation: Department of Medicine, Florida Hospital, Apopka, FL, USA.
authors.forename: Himanshu K
authors.initials: HK
authors.lastname: Khanna
authors.affiliation: Department of Medicine, Florida Hospital, Apopka, FL, USA.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Stevens
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004359:Drug Therapy, Combination; D006801:Humans; D007866:Leg / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology*; D009336:Necrosis; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers; D001786:Blood Glucose; D010975:Platelet Aggregation Inhibitors