DIABETIC MYONECROSIS IN DIABETIC KIDNEY DISEASE

N TROTT1, A DERMEDGOGLOU1, N JOHNS1, R PANDEY1

1Cairns Hospital, QLD

Background: Diabetic myonecrosis is a rare complication of poorly controlled diabetes, commonly affecting patients with pre-existing diabetic micro- and macro-vascular disease, such as diabetic nephropathy.

Case Report: A 27-year-old indigenous female presented to the Emergency Department with right thigh pain and swelling following minor trauma approximately 2 weeks prior to her presentation on a background of poorly controlled type 2 diabetes as evidenced by her HbA1c of 17.7%. Differential diagnoses for her thigh pain were excluded with ultrasound and MRI imaging, which revealed generalised oedema and myositis. She had ongoing severe right thigh pain with tachycardia and raised inflammatory markers. Further MRI imaging was performed which showed progressive, significant oedema in the anterior compartment of right thigh. She underwent a biopsy which essentially revealed myonecrosis with minimal inflammation and atrophy. Intra-operative specimens were microbiologically sterile. Management was conservative, with bed-rest and low dose aspirin despite persistent tachycardia, significantly raised inflammatory markers and difficult to control pain and swelling. Her renal function remained resilient with her serum creatinine fluctuating around the 200mmol/L (eGFR 27), and nephrotic range proteinuria (1000g/mol Cr). She could finally mobilise after 11 weeks.

Conclusions: Diabetic myonecrosis is a rare, self-limiting disease process that responds well to bed rest and analgesia, with poor outcomes from surgical intervention, and commonly co-exists with other micro- and macro-vascular complications such as diabetic nephropathy. Nephrologists need to be aware of this condition as they often provide care to this group of patients.

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