University of Wisconsin–Madison Medical College of Wisconsin

A Convoluted Picture of Diabetic Myonecrosis

Michael Hii, BS; John Ning, MD

WMJ. 2023;122(2):149-151.

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Introduction: A patient with well-controlled type 2 diabetes was found to have diabetic myonecrosis, a rare condition associated with poorly controlled type 2 diabetes. Diagnosis was masked by concern for lumbosacral plexopathy from a history of spinal cord infarct.

Case Presentation: A 49-year-old African American woman with type 2 diabetes and paraplegia secondary to spinal cord infarct presented to the emergency department with left leg swelling and weakness from her hip to toes. Hemoglobin A1c was 6.0%, and there was no leukocytosis or elevated inflammatory markers. Computed tomography showed evidence of infectious process or possible diabetic myonecrosis.

Discussion: Recent reviews show fewer than 200 reports of diabetic myonecrosis since first described in 1965. It typically is seen in poorly controlled types 1 and 2 diabetes, with average hemoglobin A1c of 9.34% at time of diagnosis.

Conclusions: Diabetic myonecrosis should be considered in diabetic patients with unexplained swelling and pain – particularly in the thigh – even with unremarkable lab values.

Author Affiliations: School of Medicine, Medical College of Wisconsin (MCW), Milwaukee, Wisconsin (Hii); Department of Internal Medicine, MCW, Milwaukee, Wis (Ning).
Corresponding Author: Michael Hii, BS, Medical College of Wisconsin, 8701 W Watertown Plank Road, Wauwatosa, WI 53226; email
Funding/Support: None declared.
Financial Disclosures: None declared.
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