A Case of Diabetic Muscle Infarction Affecting Upper and Lower Limbs / 대한류마티스학회지

ABSTRACT

Spontaneous diabetic muscle infarction (DMI) is a rare condition that usually occurs in those with longstanding microvascular complications of diabetes. Typical presentation is abrupt onset of painful swelling in the lower limbs, uncommonly in the upper limbs. We report a 49 year-old woman with DMI affecting not only both thighs but also left arm. She had already advanced diabetic complications of retinopathy, nephropathy, and neuropathy. Magnetic resonance imaging (MRI) showed findings of hyper-intense T2 weighted signals and rim enhancement after intravenously administered gadolinium at the sites of infarction. Excisional biopsy specimens of the thigh muscle contained aseptic necrotic muscle mixed with areas of muscle fiber atrophy and fibrosis. The diagnosis of DMI was considered most likely, and she was treated with muscle rest, analgesics, and physical therapy. The swelling and pain of the involved limbs improved gradually without complications. Since ten months after discharge, her symptoms resolved almost completely, and never relapsed. Hence, we report a rare case of DMI involving left arm and both thighs with review of literature.