Diabetic Muscle Infarction In End-Stage Renal Disease (ESRD):Case Report And Review

Objective: Diabetic muscle infarction(DMI) is a rare complication of diabetes, while nearly 75% of DMI patients merged with diabetic nephropathy, especially end-stage renal disease. To better understand it in ESRD patients, we report a case and performed a literature review.Methods: We describe a case with DMI. A literature review was performed to examine the clinical features, treatment, and prognosis of this condition.Results: we report a 45-year-old man who developed a painful swelling of his lateral right thigh, with no systemic infection. Laboratory values include a significantly elevated CRP, ESR and CK etc. The immunology and etiology results are negative. High signal lesion appeared on T2-weighted MRI and excluded the thromboembolism which turned up to be DMI finally. Analysis of available date for 39 cases revealed the following features: all patients developed symptoms of a sudden painful swelling, and showed a hyperintense signal on T2-weghted images and an isointense signal on T1-weighted images.50% patients were managed without muscle biopsy. With analgesics and rest, 82% patients dissipated the pain with a mean course of nearly 40 days. Though the short-term prognosis is good, patients are at high risk for recurrence, and with a mean mortality rate of 15.4% within 2 years from DMI onset.Conclusion: DMI is a rare complication of diabetes, physicians should have a high index of suspicion for DMI in patients with poorly controlled diabetic presenting with sudden onset, non-traumatic muscle pain. Excluding local infection and thromboembolism at the mean time, early MRI inspection will be the best choice for diagnosing this disease. From the data collected, we didn’t find obvious differences between ESRD patients and only diabetic patients in the clinical characters. Nowadays the treatment of DMI is limited. But we observed that CRRT can effectively improve symptoms, so it can be considered when other treatment failed. On the whole, we are still lack of experience for treatment. We need to collect more related cases to a better understanding and treatment of the disease.