Skeletal muscle infarction in diabetes mellitus

Objective. To analyze the risk factors, clinical features, and methods of d iagnosis of diabetic muscle infarction (DMI). Methods, Three patients with diabetes mellitus (DM) and skeletal muscle inf arction were studied, and 49 additional cases reported in the English liter ature (Medline database search) were reviewed. Results. Review of all 52 patients with DMI revealed a number of typical fe atures: equal sex distribution; mean age 41.5 years (range 19-81 yrs); a nu mber of risk factors [long duration of DM (mean 15.2;yrs), poor control and microvascular diabetic complications (neuropathy, retinopathy, nephropathy ) (94%), and insulin dependent type I DM (77%)]; a characteristic clinical presentation with painful diffuse muscle swelling (100%); and sometimes a m uscle mass (44%), predilection for quadriceps (62%), hip adductors (13%) an d leg muscles (13%), elevated serum creatine phosphokinase (47%), abnormal sonograms (81%), abnormal magnetic resonance image (MRI) findings (100%), t ypical histopathologic findings of a muscle infarct (100%) (ultrastructural evidence of microangiography in one patient); and a tendency toward sponta neous resolution although recurrences are common (51%). Conclusion. Skeletal muscle infarction is a rare complication of long stand ing, poorly controlled DM associated with multiple end organ microvascular sequelae. Increased clinical awareness is important for early recognition, particularly in a diabetic patient presenting with a painful thigh or leg s welling. MR imaging is the diagnostic study of choice, and in the appropria te clinical setting, may obviate the need for a muscle biopsy.