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Endocrine Abstracts (2023) 90 EP1127 | DOI: 10.1530/endoabs.90.EP1127

King Saud University Medical City, University Diabetes Center, Riyadh, Saudi Arabia


Introduction: Diabetes can involve the musculoskeletal system causing frozen shoulder, Dupuytren’s contracture, diabetic sclerodactyly, trigger finger, muscle infarction, diabetic amyotrophy, idiopathic lumbosacral radiculoplexus neuropathy, necrotizing fasciitis and many other complications. A case is described, who despite having multiple acute and chronic sequelae of diabetes, was successfully managed and discharged.

Case Presentation: 54yrs old obese, Saudi gentleman with multiple co-morbids(Type 2 DM ≥10yrs, Hypertension, Chronic kidney disease(3B,A3), Proliferative DM retinopathy(awaiting intra-vitreal injections) & Grade I diastolic dysfunction), Chronic normochromic normocytic anemia(GI endoscopy-upper)-chronic inactive gastritis,(lower)-single rectal polyp(tubular adenoma on histopathology), was re-admitted under Medicine department on 15.01.2023 with left hip pain, radiating to the thigh, with restricted activity for 2 weeks prior to the presentation. Rest of the workup-normal. Past history of proximal lower-limb weakness, double incontinence(2yrs) & cataract surgery. No allergies or addictions. Unremarkable family history He was on regular ACE-inhibitor, Calcium channel blocker, thiazide, loop diuretic, Linagliptin, statin, iron, Metformin and Glargine-100. Systemic review-unremarkable. BP 185/85mmHg, Pulse 74/m, regular, T-36.8 C, RR 19/m, O<info>2</info>sat 94%(on 6ltrsO<info>2</info>). Weight 104 kgs. Pallor+ Bilateral pitting pedal edema++, JVP raised. M. skeletal (Left hip) Upper medial thigh tender, but without warmth or erythema. Reduced passive and active movements of hip. Other joints unremarkable. CVS-S1, S2 audible+ ejection systolic murmur + Neurology-symmetrical wasting of hands & quadriceps+ absent deep tendon reflexes in lower limbs, along with bilaterally reduced vibration & pin-prick sensations. Rest-normal. The patient was diagnosed to have MRI proven extensive myositis of left pelvis & proximal thigh with focal myonecrosis and infective iliopsoas bursitis. Besides there was suspicion of early osteomyelitis of left ischio-pubic ramus & milder right sided myositis(CRP413.9 mg/l. He also developed acute on chronic kidney injury [S.Creatinine 307umol/l(59-104), and acute myocardial demand ischemia(serial ECGs-mild ST-T changes, TroponinT1040 ng/l(≥100 clinically significant), CPK438u/l(39-308), Echo[new RWMA(inferior wall) +mild LV systolic dysfunction(EF45%)], Myocardial perfusion scan-myocardial infarction of distal inferior wall. Other significant labs. Hb% 6.9g/dl, MCV89.8fl, TLC 17.8 x109/l,88% PMNs, HbA1c7.7%, S.albumin24.3g/l. CT chest-bilateral lower lobe opacities+ mild pleural effusion. No pulmonary embolism. NCV/EMG-sensorimotor axonal polyneuropathy. The patient was treated with Frusemide, packed RBCs, Albumin, Insulin, Oxygen & broad spectrum antibiotics. An US guided aspiration & C/S from left iliopsoas bursa revealed MRSA organism and was treated for both bursitis & Osteomyelitis. He improved with the given treatment and was discharged home on 09.02.23\.

Conclusion: Our patient exemplifies the presence of four co-existing musculoskeletal problems in close neighbourhood i.e. myonecrosis, myositis, infected ilopsoas bursitis and osteomyelitis. Diabetes was the common denominator amongst them.

Volume 90

25th European Congress of Endocrinology

Istanbul, Turkey
13 May 2023 - 16 May 2023

European Society of Endocrinology 

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