Skeletal muscle infarction is an uncommon manifestation of poor diabetic control. This report describes a gentleman who presented with two weeks of thigh pain and swelling, and had been referred to hospital for exclusion of deep vein thrombosis (DVT). His right thigh was markedly swollen, but soft. There was marked tenderness at the medial aspect. Right thigh circumference was 61 cm, while the left was 48.5 cm. There was no warmth or erythema. He had a full range of movements of the hip. He was able to mobilise. His CK was 1713. His leg doppler showed no DVT, but did demonstrate soft tissue swelling.
He went on to have an MRI of his thigh, which showed marked swelling of his right adductor muscle. His presentation, clinical examination and imaging all suggested the diagnosis of muscle infarction. He was managed conservatively with analgesia, and allowed to mobilise. He made a good recovery. Prior to this event, the patient had poor diabetic control as evidenced by an HbA1c of 16.0%, proliferative retinopathy, and 2.78 g proteinuria in 24 hours.
The mechanism of muscle infarction is probably one of atherothrombotic disease. Hypercoagulable states have also been implicated. Our patient did have marked proteinuria, almost reaching nephrotic range. He also had peripheral oedema and a low serum albumin. Nephrotic syndrome is an established prothrombotic state. There are no specific treatments for diabetic muscle infarction, but anecdotal reports of success with anticoagulants do exist.
Patients are at risk of subsequent episodes, usually involving a different muscle. It is also reasonable to postulate that patients with muscle infarction are at increased risk of cardiovascular disease. Thus, they need aggressive modification of risk factors.