IS DIABETIC MYONECROSIS MORE COMMON THAN WE THOUGHT? A CLUSTER OF CASES IN PATIENTS WITH END STAGE KIDNEY DISEASE IN CENTRAL AUSTRALIA

P SUBRAMANI1,2, P GEORGE1, M BROWN1,

1Alice Springs Hospital, Alice Springs, NT; 2Royal Darwin Hospital, Darwin, NT

Background: Diabetic myonecrosis, or diabetic muscle infarction (DMI) is a rare condition thought to be a complication of longstanding diabetes mellitus (DM). Since its initial description in 1965, fewer than 200 cases have been reported. We report five cases of DMI in the Indigenous population of Central Australia over a seven month period, all occurring in patients with end stage kidney disease (ESKD).

Case Reports: The first case is a 45yo woman who developed progressive pain and swelling of her right thigh following a carbuncle excision on the same thigh. Diagnosis of DMI was suggested on MRI and confirmed histologically. The initial episode resolved, but she developed DMI in her left forearm two months later in the context of a thrombosed arteriovenous fistula. Following that four other cases were diagnosed, all occurring in the lower extremity. All cases demonstrated typical MRI findings strongly suggestive of DMI. 2 cases were confirmed histologically. All cases occurred in patients with ESKD, two of whom initiated renal replacement therapy (RRT) during their admission. All patients were on statin therapy prior to presentation and had other microvascular complications of longstanding diabetes, in particular retinopathy. Analgesia and rest were the mainstay of treatment and all patients recovered without permanent disability. However, those who underwent surgical exploration including muscle biopsy took longer to recover.

Conclusion: Whilst the incidence of DMI is reported to be rare, five cases have occurred in Central Australia over a seven month period. Potential contributors include ESKD, longstanding DM, statin therapy, Indigenous background, and preceding local trauma. We plan to pursue a prospective cohort study in this population to better establish triggers, risk factors, and long-term outcomes.

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