Painful swelling of the thigh in a diabetic patient: Diabetic muscle infarction.

A 44-year-old woman with a 5-year history of poorly controlled Type 1 diabe tes mellitus presented with a painful, firm and wa rm swelling in her right thigh. Pain was severe but the patient was not febrile, and had no history of trauma or abnormal exercise. Laboratory tests showed ketoacidosis, majo r inflammation (erythrocyte sedimentation rate (ESR) = 83 mm/h), normal whi te blood cell count and normal creatine kinase level. Plain radiographs wer e normal, and there were no signs of thrombophlebitis at Doppler ultrasound . Magnetic resonance imaging (MRI) showed diffuse enlargement and an oedema tous pattern of the adductors, vastus medialis, vastus intermedius and sart orius of the right thigh. The patient's symptoms improved dramatically, mak ing biopsy unnecessary, and a diagnosis of diabetic muscular infarction was reached. Idiopathic muscular infarction is a rare and specific complicatio n of diabetes mellitus, typically presenting as a severely painful mass in a lower limb, with high ESR. The diabetes involved is generally poorly cont rolled longstanding Type 1 diabetes with established microangiopathy Differ ential diagnoses include deep vein thrombosis, acute exertional compartment syndrome, muscle rupture, soft tissue abscess, haematoma, sarcoma, inflamm atory or calcifying myositis and pyomyositis. In fact, physician awareness should allow early diagnosis on the basis of clinical presentation, routine laboratory tests and MRI, thereby avoiding biopsy and its potential compli cations as well as unnecessary investigations. Rest, symptomatic pain relie f and adequate control of diabetes usually ensure progressive total recover y within a few weeks. Recurrences may occur in the same or contralateral li mb.