Endocrine Abstracts

JOINT4019

Effective metabolic control is crucial for preventing microvascular and macrovascular complications in patients with type 1 diabetes mellitus (T1DM). Here, we present a case of a young woman with T1DM who developed two rare complications: acute insulin neuritis and diabetic myonecrosis. A 45-year-old woman with T1DM since 2009, followed by the Endocrinology Department, experienced, since her diagnosis, irregular medical follow-up, poor adherence to treatment, and inadequate glycemic control. She developed severe microvascular complications, including proliferative diabetic retinopathy (treated with photocoagulation), diabetic nephropathy, and autonomic dysfunction with gastroparesis. Additionally, she suffered from significant macrovascular complications, such as an acute myocardial infarction in 2015 (managed with angioplasty) and peripheral arterial disease of the lower limbs. In 2022 and 2023, her adherence to treatment improved, leading to intensified insulin therapy and a rapid reduction in HbA1c from 14. 2% to 6. 6%. During this period, she reported paresthetic pain in the lower limbs along with mild-to-moderate paraparesis. Electromyography confirmed moderate sensorimotor axonal neuropathy, which later progressed to Charcot neuroarthropathy. The most likely cause was treatment-induced neuropathy, also known as acute insulin neuritis. She was started on tapentadol and pregabalin, resulting in significant pain relief. She was referred to a Diabetic Foot specialist and, in October 2024, underwent surgery to stabilize her left foot. In 2023, she had a prolonged hospitalization due to diabetic myonecrosis with abscess formation in the gastrocnemius muscles. She presented with pain, swelling, and redness in the right calf, along with functional impairment that lasted for two weeks, without fever or trauma history. MRI revealed multiple abscessed collections within the muscular planes of the right leg, with an extensive inflammatory process suggestive of abscessed hematomas. A muscle biopsy confirmed acute inflammatory infiltration and necrosis of skeletal muscle, consistent with spontaneous diabetic myonecrosis. She underwent surgical drainage of the abscesses and received broad-spectrum antibiotic therapy for 20 days. Currently, she remains under regular follow-up, with HbA1c levels ranging between 7. 6% and 8. 4%. This case underscores the complexity of managing T1DM and highlights the importance of recognizing rare complications early to minimize their impact on patients’ quality of life.