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He J, Wang L, Robertson T, Rangaswamaiah S, Malabu UH. Diabetes Myonecrosis: A Debilitating Complication in an Indigenous Young Woman With Long Standing Type 1 Diabetes Mellitus. Case Rep Endocrinol 2024; 2024:8839798. [PMID: 39371631 PMCID: PMC11452241 DOI: 10.1155/2024/8839798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 08/14/2024] [Indexed: 10/08/2024] Open
Abstract
A 24-year-old Indigenous Australian female with long-standing, poorly controlled type 1 diabetes mellitus (T1DM) presented with 3 months' history of unilateral thigh swelling and pain. Her laboratory investigations showed evidence of a persistent inflammatory state with normal creatine kinase. Infectious and autoimmune investigations were negative. Imaging demonstrated evidence of muscular oedema and atrophy. Muscular pain and swelling have a broad list of differential diagnoses. This case highlights a rare but potentially debilitating complication of diabetes mellitus-diabetic myonecrosis with its challenges in reaching a definitive diagnosis due to non-specific symptomology and laboratory findings. However, it is an important differential of leg pain and swelling to consider, particularly in those with long-standing diabetes and pre-existing microvascular complications. Glycaemic control is paramount in preventing this potentially severe diabetic complication.
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Affiliation(s)
- Jinwen He
- Department of Diabetes and EndocrinologyTownsville University Hospital, Townsville, Australia
| | - Liyan Wang
- Department of Diabetes and EndocrinologyTownsville University Hospital, Townsville, Australia
| | - Thomas Robertson
- Department of Anatomical PathologyRoyal Brisbane and Women's Hospital, Herston, Australia
| | - Swetha Rangaswamaiah
- Department of Diabetes and EndocrinologyTownsville University Hospital, Townsville, Australia
| | - Usman H. Malabu
- Department of Diabetes and EndocrinologyTownsville University Hospital, Townsville, Australia
- College of Medicine and DentistryJames Cook University, Townsville, Australia
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2
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Pawar T, Malde S, Gupta S, Jeyachandran V, Kashiv P, Dubey S, Sejpal KN, Balwani M, Pasari AS, Bawankule CP. Uncommon Muscle Complications in Diabetes: A Case Report on Diabetic Muscle Infarction. Cureus 2024; 16:e68874. [PMID: 39381459 PMCID: PMC11459590 DOI: 10.7759/cureus.68874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 09/07/2024] [Indexed: 10/10/2024] Open
Abstract
Diabetic muscle infarction (DMI) is a rare but severe complication of diabetes mellitus (DM), characterised by acute muscle pain and swelling, primarily in the lower extremities. Prompt recognition and management are critical for preventing further complications. We report the case of a 54-year-old male with a long-standing history of type 2 DM and hypertension. The patient presented with acute, severe pain in the left calf, which had progressively worsened over several days. Physical examination revealed oedema and tenderness in the left calf. Laboratory investigations indicated muscle injury and inflammation, and MRI confirmed the diagnosis of DMI by showing areas of muscle inflammation. The patient was treated with hemodialysis, dual antiplatelet, and supportive care, including analgesics for pain management and stringent blood glucose control. He was advised to avoid excessive physical activity and was educated on the importance of medication adherence and lifestyle modifications. Regular follow-up was scheduled to monitor his progress and adjust the treatment plan as necessary. This case underscores the importance of considering DMI in patients with diabetes presenting with acute muscle pain. Early diagnosis and appropriate management are essential for preventing complications and improving patient outcomes. Clinicians should maintain a high index of suspicion for DMI to ensure timely and effective intervention.
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Affiliation(s)
- Twinkle Pawar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Sunny Malde
- Nephrology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Sushrut Gupta
- Nephrology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Vijay Jeyachandran
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Pranjal Kashiv
- Nephrology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Shubham Dubey
- Nephrology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Kapil N Sejpal
- Nephrology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Manish Balwani
- Nephrology, Saraswati Kidney Care Center, Nagpur, IND
- Nephrology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Amit S Pasari
- Nephrology, Saraswati Kidney Care Center, Nagpur, IND
- Nephrology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Zandee van Rilland ED, Yao L, Stevens KJ, Chung LS, Fiorentino DF, Boutin RD. Myositis and Its Mimics: Guideline Updates, MRI Characteristics, and New Horizons. AJR Am J Roentgenol 2024; 223:e2431359. [PMID: 38838235 DOI: 10.2214/ajr.24.31359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Myositis is defined as inflammation within skeletal muscle and is a subcategory of myopathy, which is more broadly defined as any disorder affecting skeletal muscle. Myositis may be encountered as a component of autoimmune and connective tissue diseases, where it is described as idiopathic inflammatory myopathy (IIM). Myositis can also be caused by infections as well as toxins and drugs, including newer classes of medications. MRI plays an important role in the diagnosis and evaluation of patients with suspected myositis, but many entities may have imaging features similar to those of myositis and can be considered myositis mimics. These include muscular dystrophies, denervation, deep venous thrombosis, diabetic myonecrosis, muscle injury, heterotopic ossification, and even neoplasms. In patients with suspected myositis, definitive diagnosis may require integrated analysis of imaging findings with clinical, laboratory, and pathology data. The objectives of this article are to review the fundamental features of myositis, including recent updates in terminology and consensus guidelines for IIMs; the most important MRI differential diagnostic considerations for myositis (i.e., myositis mimics); and new horizons, including the potential importance of artificial intelligence and multimodal integrated diagnostics in the evaluation of patients with muscle disorders.
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Affiliation(s)
| | - Lawrence Yao
- Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, MD
| | - Kathryn J Stevens
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
| | - Lorinda S Chung
- Department of Medicine, Immunology and Rheumatology Division, Stanford University School of Medicine, Stanford, CA
- Department of Medicine, Palo Alto VA Health Care System, Palo Alto, CA
| | - David F Fiorentino
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA
| | - Robert D Boutin
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
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4
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Dlamini M, Khathi A. Investigating the Effects of Diet-Induced Prediabetes on Skeletal Muscle Strength in Male Sprague Dawley Rats. Int J Mol Sci 2024; 25:4076. [PMID: 38612885 PMCID: PMC11012655 DOI: 10.3390/ijms25074076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Type 2 diabetes mellitus, a condition preceded by prediabetes, is documented to compromise skeletal muscle health, consequently affecting skeletal muscle structure, strength, and glucose homeostasis. A disturbance in skeletal muscle functional capacity has been demonstrated to induce insulin resistance and hyperglycemia. However, the modifications in skeletal muscle function in the prediabetic state are not well elucidated. Hence, this study investigated the effects of diet-induced prediabetes on skeletal muscle strength in a prediabetic model. Male Sprague Dawley rats were randomly assigned to one of the two groups (n = 6 per group; six prediabetic (PD) and six non-pre-diabetic (NPD)). The PD group (n = 6) was induced with prediabetes for 20 weeks. The diet that was used to induce prediabetes consisted of fats (30% Kcal/g), proteins (15% Kcal/g), and carbohydrates (55% Kcal/g). In addition to the diet, the experimental animals (n = 6) were supplied with drinking water that was supplemented with 15% fructose. The control group (n = 6) was allowed access to normal rat chow, consisting of 35% carbohydrates, 30% protein, 15% fats, and 20% other components, as well as ordinary tap water. At the end of week 20, the experimental animals were diagnosed with prediabetes using the American Diabetes Association (ADA) prediabetes impaired fasting blood glucose criteria (5.6-6.9 mmol/L). Upon prediabetes diagnosis, the animals were subjected to a four-limb grip strength test to assess skeletal muscle strength at week 20. After the grip strength test was conducted, the animals were euthanized for blood and tissue collection to analyze glycated hemoglobin (HbA1c), plasma insulin, and insulin resistance using the homeostatic model of insulin resistance (HOMA-IR) index and malondialdehyde (MDA) concentration. Correlation analysis was performed to examine the associations of skeletal muscle strength with HOMA-IR, plasma glucose, HbA1c, and MDA concentration. The results demonstrated increased HbA1c, FBG, insulin, HOMA-IR, and MDA concentrations in the PD group compared to the NPD group. Grip strength was reduced in the PD group compared to the NPD group. Grip strength was negatively correlated with HbA1c, plasma glucose, HOMA-IR, and MDA concentration in the PD group. These observations suggest that diet-induced prediabetes compromises muscle function, which may contribute to increased levels of sedentary behavior during prediabetes progression, and this may contribute to the development of hyperglycemia in T2DM.
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Affiliation(s)
| | - Andile Khathi
- Department of Human Physiology, School of Laboratory Medicine, Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban X54001, South Africa;
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Wells J, Sorsby SC. Diabetic myonecrosis: An easily overlooked cause of limb pain in diabetic patients. J Am Assoc Nurse Pract 2024; 36:194-196. [PMID: 37882690 DOI: 10.1097/jxx.0000000000000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/12/2023] [Indexed: 10/27/2023]
Abstract
ABSTRACT Diabetic myonecrosis (DMN) is an underdiagnosed cause of spontaneous extremity pain and swelling in patients with diabetes. Failure to consider this diagnosis in patients with recent onset of extremity pain may lead to inappropriate testing and to treatment that worsens symptoms and delays healing. The following is a case report of recurrent diabetic myonecrosis in a 36-year-old woman that highlights several typical features of this uncommon disorder. We discuss the differential diagnosis and how to rapidly identify DMN, as well as best practices for the treatment of the disorder. We approach most types of muscular pain issues with stretching and exercise, but this approach can result in increased pain and delayed resolution in patients with DMN. Nurse practitioners and other providers should consider DMN when faced with a patient with diabetes and spontaneous extremity pain and understand how to efficiently diagnose this disorder and rule out other causes.
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Shah DN, Chorya HP, Ramesh NN, Gnanasekaram S, Patel N, Sethi Y, Kaka N. Myopathies of endocrine origin: A review for physicians. Dis Mon 2024; 70:101628. [PMID: 37718136 DOI: 10.1016/j.disamonth.2023.101628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Myopathies are a common manifestation of endocrine disorders. Endocrine myopathies are often overlooked while considering differential diagnoses in patients with musculoskeletal symptoms. The hindrance to mobility and the musculoskeletal discomfort owing to these myopathies are important causes of disability and depreciated quality of life in these patients. Endocrine myopathies occur due to the effects of endogenous or iatrogenic hormonal imbalance on skeletal muscle protein and glucose metabolism, disrupting the excitation-contraction coupling. Abnormalities of the pituitary, thyroid, parathyroid, adrenal, and gonadal hormones have all been associated with myopathies and musculoskeletal symptoms. Endocrine myopathies can either be the complication of a secondary endocrine disorder or a presenting symptom of a missed underlying disorder. Therefore, an underlying endocrine abnormality must always be excluded in all patients with musculoskeletal symptoms. This review presents a compilation of various endocrine myopathies, their etiopathogenesis, clinical presentation, diagnostic modalities, and treatment protocols.
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Affiliation(s)
- Devarsh N Shah
- Government Medical College Baroda, India; PearResearch, India
| | | | - N Nishitha Ramesh
- PearResearch, India; Father Muller Medical College, Mangalore, India
| | | | - Neil Patel
- PearResearch, India; GMERS Medical College, Himmatnagar, Gujarat, India
| | - Yashendra Sethi
- PearResearch, India; Government Doon Medical College, HNB Uttarakhand Medical Education University, Dehradun, Uttarakhand, India
| | - Nirja Kaka
- PearResearch, India; GMERS Medical College, Himmatnagar, Gujarat, India.
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Dlamini M, Khathi A. Prediabetes-Associated Changes in Skeletal Muscle Function and Their Possible Links with Diabetes: A Literature Review. Int J Mol Sci 2023; 25:469. [PMID: 38203642 PMCID: PMC10778616 DOI: 10.3390/ijms25010469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
The skeletal muscle plays a critical role in regulating systemic blood glucose homeostasis. Impaired skeletal muscle glucose homeostasis associated with type 2 diabetes mellitus (T2DM) has been observed to significantly affect the whole-body glucose homeostasis, thereby resulting in other diabetic complications. T2DM does not only affect skeletal muscle glucose homeostasis, but it also affects skeletal muscle structure and functional capacity. Given that T2DM is a global health burden, there is an urgent need to develop therapeutic medical therapies that will aid in the management of T2DM. Prediabetes (PreDM) is a prominent risk factor of T2DM that usually goes unnoticed in many individuals as it is an asymptomatic condition. Hence, research on PreDM is essential because establishing diabetic biomarkers during the prediabetic state would aid in preventing the development of T2DM, as PreDM is a reversible condition if it is detected in the early stages. The literature predominantly documents the changes in skeletal muscle during T2DM, but the changes in skeletal muscle during prediabetes are not well elucidated. In this review, we seek to review the existing literature on PreDM- and T2DM-associated changes in skeletal muscle function.
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Affiliation(s)
| | - Andile Khathi
- Department of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban X54001, South Africa;
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Csonka V, Varjú C, Lendvay M. Diabetes mellitus-related musculoskeletal disorders: Unveiling the cluster of diseases. Prim Care Diabetes 2023; 17:548-553. [PMID: 37643934 DOI: 10.1016/j.pcd.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
The current study ushers in a comprehensive review in clinical research to demonstrate the prevalence of musculoskeletal (MSK) complications in diabetes mellitus and the most relevant clinical aspects. In particular, revealing the early symptoms of the disorders, the pathology lurking behind the complications and their optimal management. In diabetes mellitus, MSK complications are common and are largely due to similar pathogenetic factors responsible for the internal organ complications associated with diabetes leading to chronic low-intensity inflammatory processes. MSK disorders develop by vasculopathy, neuropathy, arthropathy or combinations of the above, which are not specific to diabetes. However, their prevalence is significantly increased in diabetes and contributes to the disability impairing patients' quality of life. Locomotor disease affects approximately 34.4-83.5 % of patients suffering from type-2 diabetes mellitus. Several musculoskeletal abnormalities (cheiroarthropathy, Dupuytren's contracture, trigger finger, ect.) can be diagnosed upon physical examination, although certain symptoms (frozen shoulder, neurogenic arthropathy, septic arthritis, etc.) require differential diagnostic considerations. Early identification regarding characteristic symptoms in the treatment reducing inflammation and pain, followed with increasingly strenuous exercise therapy, aligned with optimal management of carbohydrate metabolism, proves essential in alleviating MSK complications.
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Affiliation(s)
- Viktória Csonka
- Department of Rheumatology, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Cecília Varjú
- Department of Rheumatology and Immunology, Medical School, University of Pécs, Pécs, Hungary
| | - Marcell Lendvay
- Department of Rheumatology and Immunology, Medical School, University of Pécs, Pécs, Hungary.
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Zee K, Poplawski M, Coleman J, Popovich J. Diabetic Myonecrosis of the Axilla: A Novel Case With Severe Clinical Features. Cureus 2023; 15:e46028. [PMID: 37900489 PMCID: PMC10602711 DOI: 10.7759/cureus.46028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Diabetic myonecrosis is a rare and poorly understood complication of long-standing, inadequately controlled diabetes mellitus. Theoretical mechanisms contributing to the pathophysiology of diabetic myonecrosis include microvascular complications due to advanced glycation end-products, ischemia-reperfusion injuries, and dysregulated coagulation-fibrinolysis activity. Case reports of diabetic myonecrosis most commonly describe diabetic patients with chronically poor glycemic control who experience isolated swelling and severe pain in a unilateral lower limb with no signs of infection or systemic toxicity. Due to the rarity of this condition, there are currently no treatment guidelines. This case describes a 58-year-old male with a history of uncontrolled diabetes who presented with diabetic ketoacidosis with mixed hypovolemic and septic shock. Diabetic myonecrosis was incidentally discovered in the patient's right latissimus dorsi with CT imaging and subsequent surgical exploration. Spontaneous diabetic myonecrosis may mimic several other serious conditions and elicit suboptimal management strategies, particularly in the context of atypical presentations.
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Affiliation(s)
- Kalvin Zee
- General Surgery, MercyOne Medical Center, Des Moines, USA
| | | | - Jesse Coleman
- General Surgery, MercyOne Medical Center, Des Moines, USA
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Emma CL, Sara KB, Gregory PJ, Matthew PG. Diabetic muscle infarction: A case report. J Family Med Prim Care 2023; 12:2161-2163. [PMID: 38024884 PMCID: PMC10657035 DOI: 10.4103/jfmpc.jfmpc_1228_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/12/2022] [Accepted: 02/07/2023] [Indexed: 12/01/2023] Open
Abstract
Diabetes muscle infarction (DMI) is a rare complication of diabetes in which patients who present with DMI more commonly have some form of kidney disease in addition to diabetes mellitus. DMI typically presents with muscle pain and swelling. Diagnosis typically requires imaging (MRI with gadolinium contrast is the gold standard) and a variety of laboratory studies may aid in the diagnosis. Treatment of DMI varies depending on the severity of the case. In general patients recover quickly, though there is a risk of recurrence. This particular case report is a 36 year old female who presented with right lower extremity pain and chronic kidney disease. Case reports like this are important to highlight DMI as it is likely to become more common as diabetes continues to become more prevalent.
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Affiliation(s)
- C Levine Emma
- Department of Surgery, Vanderbilt University, Nashville TN, USA
| | - K Brennan Sara
- Department of Internal Medicine University of Vermont, Burlington Vermont, USA
| | | | - P Gilbert Matthew
- Division of Endocrinology and Diabetes, University of Vermont, Burlington Vermont, USA
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Kurup V, Nagoshi Y, Rivera-Zengotita M, Maska A. Recurrent diabetic myonecrosis in an African American woman with long-standing uncontrolled type 2 diabetes: a case report. J Med Case Rep 2023; 17:271. [PMID: 37312231 PMCID: PMC10262437 DOI: 10.1186/s13256-023-03896-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/19/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Diabetic myonecrosis, also called diabetic muscle infarction, is an uncommon complication of uncontrolled diabetes mellitus and is frequently underdiagnosed. The objective of this case report is to highlight the challenges in the early diagnosis and treatment of this disease. CASE PRESENTATION A 51-year-old African American woman with a long history of uncontrolled diabetes mellitus presented to her primary care physician with right thigh pain. A diagnosis of diabetes myonecrosis was made on the basis of magnetic resonance imaging, biopsy, and negative autoimmune panel. After failing conservative treatment, the patient was treated with prednisone with gradual improvement of her symptoms. However, she had a recurrence of myonecrosis almost one year after her original presentation, which was also treated with prednisone. The recurrence had a shorter course and the patient recovered well. Challenges to the treatment in this patient were her debilitating pain and her underlying chronic kidney disease. CONCLUSIONS A high index of suspicion for diabetic myonecrosis is necessary when a patient with diabetes presents with unilateral focal leg pain and swelling. Magnetic resonance imaging and biopsy can help confirm the diagnosis. Prednisone may be considered in patients who lack spontaneous regression with just rest. Educating healthcare professionals about this uncommon condition is of utmost importance in avoiding unnecessary testing and inappropriate treatment.
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Affiliation(s)
- Varsha Kurup
- Division of General Internal Medicine, Department of Internal Medicine, University of Florida College of Medicine, PO Box 100277, Gainesville, FL, 32610, USA
| | - Ying Nagoshi
- Division of General Internal Medicine, Department of Internal Medicine, University of Florida College of Medicine, PO Box 100277, Gainesville, FL, 32610, USA
| | - Marie Rivera-Zengotita
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Adlira Maska
- Division of General Internal Medicine, Department of Internal Medicine, University of Florida College of Medicine, PO Box 100277, Gainesville, FL, 32610, USA.
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Johnson AM, Oo ZT, Oo TS, Hunter DA, Htet ZM, Bejugam VR, Purice G. A Rare and Unique Complication of Uncontrolled Type 2 Diabetes Mellitus: A Case Report and Literature Review of Spontaneous Diabetic Myonecrosis. Cureus 2023; 15:e37099. [PMID: 37168143 PMCID: PMC10166362 DOI: 10.7759/cureus.37099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 05/13/2023] Open
Abstract
There are many microvascular and macrovascular complications regarding uncontrolled diabetes mellitus (DM). Among them, diabetes myonecrosis is one of the complications but rarely seen in the uncontrolled DM patient population. Here, we present a rare case of DM myonecrosis in a patient with elevated hemoglobin A1c (HbA1c) of 18.2% and discuss the literature review of diabetes myonecrosis. A 48-year-old male with hypertension and uncontrolled type 2 diabetes mellitus (T2DM) with hemoglobin A1c of 18.2% presented with progressive swelling and pain in the right thigh for two days. Physical examination demonstrated swollen and tense tender right thigh with a circumference five inches larger than the left. Computed tomography (CT) and magnetic resonance imaging (MRI) results revealed severe myositis of the right leg, likely myonecrosis, and associated fascial edema/fasciitis. The patient was also complicated with diffuse anasarca, which was corrected with albumin transfusion and furosemide. Aspirin and lisinopril were also started for antithrombotic and cardioprotective effects. The right thigh swelling improved, and the patient could ambulate with supportive measures and regular physical therapy (PT). He was discharged home after 45 days of hospitalization. Diabetic myonecrosis is a rare condition and hence is underdiagnosed. In patients with uncontrolled diabetes, especially with diabetic complications, physicians should have high clinical suspicion to diagnose diabetic myonecrosis when patients present with an acute unilateral painful swollen limb. Our case highlights the complicated course of diabetes myonecrosis with anasarca, improved with supportive measures.
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Affiliation(s)
- Adejoke M Johnson
- Medicine, Jacobi Medical Center/North Central Bronx Hospital, Bronx, USA
| | - Zin Thawdar Oo
- Internal Medicine, Jacobi Medical Center/North Central Bronx Hospital, Bronx, USA
| | - Thar Sann Oo
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA
| | | | - Zin M Htet
- Internal Medicine, James J. Peters Veterans Affairs (VA) Medical Center, Bronx, USA
| | - Vishal Reddy Bejugam
- Internal Medicine, Jacobi Medical Center/North Central Bronx Hospital, Bronx, USA
| | - Gabriel Purice
- Internal Medicine, North Central Bronx Hospital, Bronx, USA
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Diabetic myonecrosis of isolated internal oblique muscle, a rare presentation of an uncommon condition: A case report. Int J Diabetes Dev Ctries 2023. [DOI: 10.1007/s13410-023-01187-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
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Botero Suarez CS, Matos M, Suryanarayanan S. Diabetic Muscle Infarction: An Uncommon Diabetic Complication With a Lack of Standardized Treatment. JCEM CASE REPORTS 2023; 1:luad018. [PMID: 37908460 PMCID: PMC10580423 DOI: 10.1210/jcemcr/luad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Indexed: 11/02/2023]
Abstract
Diabetic muscle infarction (DMI) is a rare yet serious complication that has been strongly associated with uncontrolled diabetes, although other risk factors are unclear. DMI is an uncommon complication of diabetes with a lack of structured guidelines for evaluation or management. End-stage renal disease (ESRD) could have further implications in patients with DMI in terms of management given that nonsteroidal anti-inflammatory drugs (NSAIDs), which have been shown to reduce the recovery times and recurrence of DMI, could be contraindicated. We present a rare case of DMI in an African American man with ESRD who presented for new-onset right lower-extremity pain and swelling. We discuss the challenges involved with the diagnosis and treatment of this rare condition. This case adds to the knowledge of DMI, which is limited because of the low incidence of this condition, and it helps us understand how this condition affects the African American population and patients with ESRD.
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Affiliation(s)
- Carlos S Botero Suarez
- Endocrinology, Diabetes, and Metabolism Fellowship, University of Central Florida HCA Healthcare GME, Greater Orlando, Kissimmee, FL 34741, USA
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL 32827, USA
| | - Moises Matos
- Endocrinology, Diabetes, and Metabolism Fellowship, University of Central Florida HCA Healthcare GME, Greater Orlando, Kissimmee, FL 34741, USA
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL 32827, USA
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Rabczyński M, Fenc M, Kuźnik E, Lubieniecki P, Hałoń A. Diabetic Muscle Infarction-A Rare Diabetic Complication: Literature Review and Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3390. [PMID: 36834084 PMCID: PMC9966745 DOI: 10.3390/ijerph20043390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
We present a case of a 31-year-old patient with type 1 diabetes diagnosed at the age of 6. Diabetes is complicated with neuropathy, retinopathy, and nephropathy. He has been admitted to the diabetes ward due to inadequate diabetes control. Gastroscopy and abdominal CT were performed, and gastroparesis was confirmed as an explanation for postprandial hypoglycemia. During hospitalization, the patient reported sudden pain localized on the lateral, distal part of his right thigh. The pain occurred at rest and was aggravated by movement. Diabetic muscle infarction (DMI) is a rare complication of long-lasting, uncontrolled diabetes mellitus. It usually occurs spontaneously, without any previous infection or trauma, and is often misdiagnosed clinically as an abscess, neoplasm, or myositis. DMI patients suffer from pain and swelling of the affected muscles. Radiological examinations, including MRI, CT, and USG, are most important for the diagnosis, assessing the extent of involvement and differentiating DMI from other conditions. However, sometimes a biopsy and histopathological examination are necessary. The optimal treatment has still not been determined. There is also a potential risk of DMI recurrence.
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Affiliation(s)
- Maciej Rabczyński
- Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Monika Fenc
- Department of Radiology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Edwin Kuźnik
- Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Paweł Lubieniecki
- Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Agnieszka Hałoń
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, Marcinkowskiego 1, 50-368 Wrocław, Poland
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16
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Loh WJ, Watts GF. The Management of Hypercholesterolemia in Patients with Neuromuscular Disorder. Curr Atheroscler Rep 2023; 25:43-53. [PMID: 36609642 DOI: 10.1007/s11883-022-01077-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW We describe and discuss the safety of statins and non-statin drugs in neuromuscular disorders (NMDs). We also propose a pragmatic model of care for the management of such cases. RECENT FINDINGS Patients with both NMD and hypercholesterolemia may be particularly disadvantaged owing to the toxic effects of cholesterol-lowering therapy and the inability to take medication. Specifically, the management of hypercholesterolemia in patients with NMD is complicated by the increased risk of statin-related myotoxicity and concerns that statins may aggravate or possibly induce the onset of a specific NMD. The most severe form of statin-related myotoxicity is immune-mediated necrotizing myopathy. Management of hypercholesterolemia in patients with NMDs include treating modifiable factors, consideration of toxicity risk of statin, use of non-statin lipid lowering agents, noting possible drug interactions, and careful monitoring.
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Affiliation(s)
- Wann Jia Loh
- School of Medicine, University of Western Australia, Perth, WA, 6001, Australia.
- Cardiometabolic Service, Department of Cardiology and Internal Medicine, Royal Perth Hospital, Perth, Australia.
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
| | - Gerald F Watts
- School of Medicine, University of Western Australia, Perth, WA, 6001, Australia
- Cardiometabolic Service, Department of Cardiology and Internal Medicine, Royal Perth Hospital, Perth, Australia
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17
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Salastekar N, Su A, Rowe JS, Somasundaram A, Wong PK, Hanna TN. Imaging of Soft Tissue Infections. Radiol Clin North Am 2023; 61:151-166. [DOI: 10.1016/j.rcl.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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18
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Choi JH, Kim HR, Song KH. Musculoskeletal complications in patients with diabetes mellitus. Korean J Intern Med 2022; 37:1099-1110. [PMID: 36300322 PMCID: PMC9666255 DOI: 10.3904/kjim.2022.168] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/16/2022] [Indexed: 11/27/2022] Open
Abstract
Musculoskeletal conditions are common in patients with diabetes. Several musculoskeletal disorders are viewed as chronic complications of diabetes because epidemiological studies have revealed high correlations between such complications and diabetes, but the pathophysiological links with diabetes remains unclear. Genetic predispositions, shared risk factors, microvascular impairments, progressive accumulation of advanced glycation end-products, and diabetic neuropathy may underlie the development of musculoskeletal disorders. Musculoskeletal complications of diabetics have received less attention than life-threatening microvascular or macrovascular complications. Here, we review several diabetic musculoskeletal complications with a focus on the clinical importance of early recognition and management, which would improve quality of life and physical function.
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Affiliation(s)
- Jong Han Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University School of Medicine, Seoul,
Korea
| | - Hae-Rim Kim
- Division of Rheumatology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul,
Korea
| | - Kee-Ho Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University School of Medicine, Seoul,
Korea
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19
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Giha HA, Sater MS, Alamin OAO. Diabetes mellitus tendino-myopathy: epidemiology, clinical features, diagnosis and management of an overlooked diabetic complication. Acta Diabetol 2022; 59:871-883. [PMID: 35291027 DOI: 10.1007/s00592-022-01860-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/22/2022] [Indexed: 12/13/2022]
Abstract
Tendino-myopathy, an unexplored niche, is a non-vascular unstated T2DM complication, which is largely disregarded in clinical practice, thus, we aim to explore it in this review. Literature search using published data from different online resources. Epidemiologically, reported prevalence varies around 10-90%, which is marked variable and unreliable. Clinically, diabetic tendino-myopathy is typified by restriction of movement, pain/tenderness, cramps and decreased functions. Moreover, myopathy is characterized by muscle atrophy, weakness and ischemia, and tendinopathy by deformities and reduced functions/precision. In tendonapthy, the three most affected regions are: the hand (cheiroarthropathy, Dupuytren's contracture, flexor tenosynovitis and carpel tunnel syndrome), shoulder (adhesive capsulitis, rotator cuff tendinopathy and tenosynovitis) and foot (Achilles tendinopathy with the risk of tear/rupture), in addition to diffuse idiopathic skeletal hyperostosis. Pathologically, it is characterized by decreased muscle fiber mass and increased fibrosis, with marked extracellular matrix remodeling and deposition of collagens. The tendon changes include decreased collagen fibril diameter, changed morphology, increased packing and disorganization, with overall thickening, and calcification. Diagnosis is basically clinical and radiological, while diagnostic biomarkers are awaited. Management is done by diabetes control, special nutrition and physiotherapy, while analgesics, steroids and surgery are used in tendinopathy. Several antisarcopenic drugs are in the pipeline. This review aims to bridge clinical practice with research and update routine diabetic checkup by inclusion of tendino-myopathies in the list with an emphasis on management.
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Affiliation(s)
- Hayder A Giha
- Medical Biochemistry and Molecular Biology, Khartoum, Sudan.
| | - Mai S Sater
- Department of Biochemistry, College of Medicine and Medical Sciences (CMMS), Arabian Gulf University (AGU), Manama, Kingdom of Bahrain
| | - Osman A O Alamin
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Alneelain University, Khartoum, Sudan
- Interventional Cardiology, Ahmad Gasim Cardiac Centre, Ahmad Gasim Hospital, Khartoum North, Sudan
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20
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Ramachandran V. Myonecrosis complicating uncontrolled diabetes mellitus. Proc AMIA Symp 2022; 35:693-694. [DOI: 10.1080/08998280.2022.2086787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Vignesh Ramachandran
- Department of Dermatology, New York University, New York, New York
- Department of Internal Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
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21
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Solankee J, Zaki T, Hoff E, Chowdhury S. Novel case of diabetic myonecrosis in a teenage patient with type 2 diabetes mellitus. BMJ Case Rep 2022; 15:e246173. [PMID: 35236676 PMCID: PMC8895903 DOI: 10.1136/bcr-2021-246173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/04/2022] Open
Abstract
Diabetic myonecrosis is a rare complication of diabetes that is typically described in patients with long-standing, uncontrolled diabetes. We report a case in which diabetic myonecrosis presents as an early complication of diabetes. To our knowledge, this is the first report of diabetic myonecrosis observed in an adolescent patient with type 2 diabetes. A 16-year-old girl presented with acute-onset, bilateral lower extremity pain and tenderness concerning for bilateral gastrocnemius myonecrosis in the setting of poorly controlled type 2 diabetes for at least 4-5 years. Investigations revealed elevated creatine kinase levels and MRI suggestive of myonecrosis. A left gastrocnemius muscle biopsy had histological findings consistent with active myofibre necrosis and multifocal perivascular lymphocytic infiltration consistent with diabetic myonecrosis. The patient's symptoms improved after 11 days of treatment with intravenous fluids, non-steroidal anti-inflammatory drugs, glycaemic control and physical therapy.
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Affiliation(s)
- Jasmina Solankee
- Physical Medicine & Rehabilitation, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Timothy Zaki
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Emily Hoff
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shweta Chowdhury
- Division of Hospitalist Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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22
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Happaerts S, Wieërs M, Vander Mijnsbrugge W, Godinas L, Van Raemdonck D, Ceulemans LJ, Vos R, Verleden GM. Azole-Induced Myositis after Combined Lung-Liver Transplantation. Case Rep Transplant 2022; 2022:7323755. [PMID: 35345837 PMCID: PMC8957034 DOI: 10.1155/2022/7323755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 02/01/2022] [Indexed: 02/05/2023] Open
Abstract
Lung transplant recipients experience a high rate of invasive pulmonary aspergillosis infections, for which voriconazole is the treatment of choice. We report a patient who developed voriconazole-induced myositis that relapsed after one dose of isavuconazole. Our patient was a 38-year-old man who received a single sequential lung transplantation and liver transplantation because of end-stage cystic fibrosis. He presented to our emergency room with acute pain in both forearms at 3 weeks after voriconazole was initiated for invasive pulmonary aspergillosis infection. Levels of voriconazole were normal during the course of therapy. After stopping voriconazole, the symptoms decreased but relapsed after one dose of isavuconazole. Other causes of muscle pain and inflammation were excluded. Magnetic resonance imaging of both arms showed muscle edema in both arms, including involvement of the fascia, consistent with myositis. There were no signs of necrosis. Isavuconazole was discontinued, and the corticosteroid dose was temporarily increased, with rapid resolution of all complaints. Our patient is the fourth reported case of voriconazole-induced myositis, and the first whose symptoms relapsed after initiating isavuconazole.
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Affiliation(s)
- Sofie Happaerts
- Department of Respiratory Diseases and Lung Transplantation, University Hospital Gasthuisberg, Leuven, Belgium
| | - Michiel Wieërs
- Department of Respiratory Diseases and Lung Transplantation, University Hospital Gasthuisberg, Leuven, Belgium
| | | | - Laurent Godinas
- Department of Respiratory Diseases and Lung Transplantation, University Hospital Gasthuisberg, Leuven, Belgium
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery and Lung Transplantation, University Hospital Gasthuisberg, Leuven, Belgium
| | - Laurens J. Ceulemans
- Department of Thoracic Surgery and Lung Transplantation, University Hospital Gasthuisberg, Leuven, Belgium
| | - Robin Vos
- Department of Respiratory Diseases and Lung Transplantation, University Hospital Gasthuisberg, Leuven, Belgium
| | - Geert M. Verleden
- Department of Respiratory Diseases and Lung Transplantation, University Hospital Gasthuisberg, Leuven, Belgium
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23
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Tang J, Sun L, Huang Q, Wu YW, Li X, Deng HH, Sun JZ, Dai Z, Xu YC. Case report: Diabetic muscle infarction with diabetic ketoacidosis: A rare complication of diabetes. Front Endocrinol (Lausanne) 2022; 13:1112703. [PMID: 36714605 PMCID: PMC9877325 DOI: 10.3389/fendo.2022.1112703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Diabetic muscle infarction (DMI), which is also referred to as diabetic myonecrosis, is a rare and long-term complication of poorly controlled diabetes mellitus, while we found that acute diabetes decompensation, such as diabetic ketoacidosis (DKA), could also stimulate the occurrence and development of DMI. CASE PRESENTATION A 23-year-old woman with type 1 diabetes presented with a 10-day history of nausea, vomiting, pain, and swelling of her left leg. Her urine ketone test was positive. The 3-beta-hydroxybutyrate and leukocyte counts and creatine kinase levels were elevated. Magnetic resonance imaging of the left thigh revealed extensive deep tissue oedema and an increase in the T2 signal in the involved muscles. Once the diagnosis of DMI was made, she was managed with rest, celecoxib, clopidogrel and aggressive insulin therapy. Three months after treatment, the patient reported complete resolution of symptoms. CONCLUSION DMI is a rare DM complication with a high recurrence rate, commonly presenting with chronic complications, while our case report shows that acute diabetes decompensation, such as DKA, can stimulate the occurrence and development of DMI. Timely diagnosis and appropriate treatment could shorten the recovery time.
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Affiliation(s)
| | | | | | | | | | | | | | - Zhe Dai
- *Correspondence: Zhe Dai, ; Yan-Cheng Xu,
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24
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Campbell WW, Landau M. Treatment and Management of Segmental Neuromuscular Disorders. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00017-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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25
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Ahmad F, Michalski J, Winterton M, Simcock X, Wysocki RW. Spontaneous Diabetic Myonecrosis Presenting as Acute Carpal Tunnel Syndrome. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:53-56. [PMID: 35415597 PMCID: PMC8991726 DOI: 10.1016/j.jhsg.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/20/2021] [Indexed: 11/25/2022] Open
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26
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Lane KL, Weinreb A, Chow K, Weinreb J. A Case of Diabetic Myonecrosis. AACE Clin Case Rep 2021; 7:383-384. [PMID: 34765737 PMCID: PMC8573271 DOI: 10.1016/j.aace.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kyrstin L. Lane
- Division of Endocrinology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
- Address correspondence and reprint requests to Dr Kyrstin L. Lane, Division of Endocrinology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Ari Weinreb
- Division of Rheumatology, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Kira Chow
- Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Jane Weinreb
- Division of Endocrinology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
- Division of Endocrinology, VA Greater Los Angeles Healthcare System, Los Angeles, California
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27
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Boavida L, Carvalho J, Oliveira S, Delgado Alves J. Muscle Infarction Following Rapid Glycemic Control in a Patient With Diabetes-Associated Microvascular Disease. Cureus 2021; 13:e17182. [PMID: 34540416 PMCID: PMC8439395 DOI: 10.7759/cureus.17182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 11/25/2022] Open
Abstract
We report a case of a 40-year-old African male with a history of diabetes mellitus with multiple microvascular complications, having recently initiated insulin treatment with a rapid decline in glycosylated hemoglobin (HbA1c) concentration. The patient presented with a sudden onset of right thigh pain and swelling not associated with trauma. Blood work revealed elevated inflammatory markers. A presumptive diagnosis of pyomyositis was made and the patient was treated with intravenous antibiotics with no improvement. Diabetic muscle infarction was then considered and confirmed by magnetic resonance imaging of the affected thigh. As with retinopathy and neuropathy deterioration that have been described as secondary to an aggressive glycemic control, it is possible that muscle myonecrosis may have been consequent to the rapid HbA1c normalization.
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Affiliation(s)
- Leonor Boavida
- Department of Internal Medicine IV, Hospital Professor Doutor Fernando Fonseca, Amadora, PRT
| | - Joana Carvalho
- Department of Internal Medicine IV, Hospital Professor Doutor Fernando Fonseca, Amadora, PRT
| | - Susana Oliveira
- Department of Internal Medicine IV, Systemic Immune-Mediated Diseases Unit (UDIMS), Hospital Professor Doutor Fernando Fonseca, Amadora, PRT
| | - José Delgado Alves
- Department of Internal Medicine IV, Systemic Immune-Mediated Diseases Unit (UDIMS), Hospital Professor Doutor Fernando Fonseca, Amadora, PRT
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28
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Wagemann J, Keller S, Noriega MDLM, Stenzel W, Schneider U, Krusche M. A new therapeutic approach with tocilizumab in a 39-year-old patient with recurrent diabetic myonecrosis. Mod Rheumatol Case Rep 2021; 6:59-63. [PMID: 34505150 DOI: 10.1093/mrcr/rxab016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/10/2021] [Accepted: 07/14/2021] [Indexed: 11/12/2022]
Abstract
We report the case of a 39-year-old female patient with acute painful swelling of the left thigh and symmetric muscle weakness in both upper legs. The patient had a history of long-standing, poorly controlled type 1 diabetes which required dialysis. Serum inflammatory markers were highly elevated. Magnetic resonance imaging (MRI) indicated necrotic or inflammatory colliquation. As antibiotic therapy did not lead to clinical improvement, a successful anti-inflammatory therapy with prednisolone was initiated. Three months later, the patient presented with a new onset of progressive and painful muscle swelling of the right thigh. MRI showed pronounced swelling of the right adductor muscles and inflammatory markers were massively elevated. In the absence of autoantibodies or any infectious agents and the recurrent symptomatology, relapsing diabetogenic myonecrosis was diagnosed. Initially, clinical improvement could only be achieved with high-dose glucocorticosteroids. Intravenous immunoglobulins did not show an effect, whereas serological and clinical remission was achieved after we administered tocilizumab intravenously. Diabetic myonecrosis is a rare complication of long-term, poorly controlled diabetes mellitus. Acute muscle pain and elevated inflammatory markers should prompt suspicion. Contralateral muscle involvement is also suggestive of the disease. The optimisation of diabetes treatment is crucial in order to prevent further disease complications.
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Affiliation(s)
- Judith Wagemann
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sarah Keller
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Werner Stenzel
- Department of Neuopathology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Udo Schneider
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Krusche
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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29
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Sim J, Ting Y, Low E. Tabetic arthropathy of the knee, complicated by lower limb myonecrosis. BMJ Case Rep 2021; 14:14/7/e242753. [PMID: 34281942 DOI: 10.1136/bcr-2021-242753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jordan Sim
- Tan Tock Seng Hospital, National Healthcare Group, Singapore .,Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Yonghan Ting
- Tan Tock Seng Hospital, National Healthcare Group, Singapore.,Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Eugene Low
- Tan Tock Seng Hospital, National Healthcare Group, Singapore.,Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
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30
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Diabetic Muscle Infarction: Resolution of Rare Microangiopathy with Over-The-Counter Medication. Case Rep Med 2021; 2021:5555051. [PMID: 34335786 PMCID: PMC8294950 DOI: 10.1155/2021/5555051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/05/2021] [Indexed: 11/18/2022] Open
Abstract
Diabetic muscle infarction (DMI) is a rare complication of poorly controlled type 1 and type 2 diabetes seen mostly in those who have already experienced microvascular complications. Currently, the incidence and prevalence of DMI are difficult to conclude, and there is no clear algorithm or standard of care in managing this condition. Pathogenesis of the microangiopathy of DMI remains unclear. A major finding in this investigation of DMI emphasizes that, within 2–17 weeks, patients who initiate low-dose acetylsalicylic acid, bed rest, and close outpatient follow-up see significant size reduction of lower extremity mass and complete resolution of pain without being subjected to invasive muscle biopsy.
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31
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Naredi M, Adhikari N, Bhardwaj GP, Saxena S, Bansal R, Sharma A. Diabetic myonecrosis in end-stage renal disease. THE NATIONAL MEDICAL JOURNAL OF INDIA 2021; 34:206-210. [PMID: 35112543 DOI: 10.25259/nmji_191_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Diabetic myonecrosis or muscle infarction (DMI), a clinicoradiological entity is an underdiagnosed complication of diabetes mellitus. It refers to spontaneous aseptic necrosis of skeletal muscles commonly of the lower limb without evidence of any large vessel disease. It presents as painful swollen limb without any external insult in patients with long-standing diabetes mellitus with other microvascular complications especially nephropathy. We present four instances of DMI in our patients who had end-stage renal disease with a varied course.
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Affiliation(s)
- Mohit Naredi
- Department of Nephrology, Pushpawati Singhania Research Institute, Press Enclave Road, Sheikh Sarai Phase 1, New Delhi 110017, India
| | - Navneet Adhikari
- Department of Orthopaedics, Pushpawati Singhania Research Institute, Press Enclave Road, Sheikh Sarai Phase 1, New Delhi 110017, India
| | - Gaurav Prakash Bhardwaj
- Department of Orthopaedics, Pushpawati Singhania Research Institute, Press Enclave Road, Sheikh Sarai Phase 1, New Delhi 110017, India
| | - Sanjeev Saxena
- Department of Nephrology, Pushpawati Singhania Research Institute, Press Enclave Road, Sheikh Sarai Phase 1, New Delhi 110017, India
| | - Ravi Bansal
- Department of Nephrology, Pushpawati Singhania Research Institute, Press Enclave Road, Sheikh Sarai Phase 1, New Delhi 110017, India
| | - Ankit Sharma
- Department of Nephrology, Pushpawati Singhania Research Institute, Press Enclave Road, Sheikh Sarai Phase 1, New Delhi 110017, India
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32
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Patibandla S, Auron M, Olson AP, Chamberlain S, Pendharkar SS. A Painful Coincidence? J Hosp Med 2021; 16:371-375. [PMID: 34129490 DOI: 10.12788/jhm.3514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 08/04/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Saikrishna Patibandla
- Department of Medicine, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York
| | - Moises Auron
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Andrew Pj Olson
- Departments of Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Samantha Chamberlain
- Department of Emergency Medicine, Ascension St John's Hospital, Detroit, Michigan
| | - Sima S Pendharkar
- Department of Medicine, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York
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33
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Kaneko K, Sawada S, Otake S, Endo A, Imai J, Miyagi S, Kamei T, Katagiri H. Diabetic Muscle Infarction with High Fever. Am J Med 2020; 133:e594-e595. [PMID: 32289304 DOI: 10.1016/j.amjmed.2020.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Keizo Kaneko
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi Japan
| | - Shojiro Sawada
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi Japan
| | - Sonoko Otake
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi Japan
| | - Akira Endo
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi Japan
| | - Junta Imai
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi Japan
| | - Shigehito Miyagi
- Department of Surgery, Tohoku University Hospital, Sendai, Miyagi Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University Hospital, Sendai, Miyagi Japan
| | - Hideki Katagiri
- Department of Diabetes and Metabolism, Tohoku University Hospital, Sendai, Miyagi Japan.
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Sureja NP, Devarasetti PK, Rajasekhar L. Diabetic myonecrosis: an unusual mimicker of idiopathic inflammatory myositis. J R Coll Physicians Edinb 2020; 50:148-151. [PMID: 32568286 DOI: 10.4997/jrcpe.2020.214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Diabetic myonecrosis or diabetic muscle infarction (DMI), is a very rare and under-recognised complication of poorly controlled long-standing diabetes mellitus. We report a case of a 59-year-old male, who had diabetes for ten years. He presented with bilateral thigh pain of insidious onset for three months and difficulty in walking, with a similar episode in his right thigh in 2015. Creatine phosphokinase (CPK) was one and half times the normal upper limit. Magnetic resonance imaging (MRI) of his thighs showed symmetrical bulky muscles with hyperintensities on T2-weighted and short tau inversion recovery (STIR) images, supporting a clinical diagnosis of idiopathic inflammatory myositis (IIM). However, a review of histopathology slides of a muscle biopsy from the right vastus lateralis performed in 2015 showed muscle fibre ischaemic necrosis suggestive of muscle infarction. Thus a diagnosis of recurrent diabetic myonecrosis was made and the patient was treated with bed rest, opioids and aspirin with gradual recovery.
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Affiliation(s)
- Nayan Patel Sureja
- Department of Clinical Immunology and Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Phani Kumar Devarasetti
- Department of Clinical Immunology and Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Liza Rajasekhar
- Department of Clinical Immunology and Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad, India,
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35
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Ahmed S, Fairley R. Diabetic Muscle Infarction. Clin Pract Cases Emerg Med 2020; 4:99-100. [PMID: 32064441 PMCID: PMC7012565 DOI: 10.5811/cpcem.2019.10.45483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 10/22/2019] [Accepted: 10/30/2019] [Indexed: 11/11/2022] Open
Abstract
A 58-year-old male with past medical history of diabetes mellitus presented with pain to the bilateral groin for six weeks. Magnetic resonance imaging of the patient’s lower extremities revealed acute myoedema, and he was diagnosed with myositis secondary to diabetic muscle infarction.
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Affiliation(s)
- Sophia Ahmed
- UT Health San Antonio, Department of Emergency Medicine, San Antonio, Texas
| | - Romeo Fairley
- UT Health San Antonio, Department of Emergency Medicine, San Antonio, Texas
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36
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Kempegowda P, Melson E, Langman G, Khattar F, Karamat M, Altaf QA. Diabetic myonecrosis: an uncommon diabetic complication. Endocrinol Diabetes Metab Case Rep 2019; 2019:1-4. [PMID: 32677424 PMCID: PMC6790895 DOI: 10.1530/edm-19-0067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Summary Diabetic myonecrosis, also known as diabetic muscle infarction is a rare complication of diabetes mellitus usually associated with longstanding suboptimal glycaemic control. Although theories of atherosclerosis, diabetic microangiopathy, vasculitis, ischaemia-reperfusion injury and hypercoagulable state have been proposed to explain the pathophysiology, none of these have been able to individually explain the pathophysiology in entirety. Diabetic renal disease is the most common risk factor for developing DMN and its recurrence. The diagnosis is often missed due to lack of awareness and the presentation mimicking other conditions associated with DM. The routine laboratory investigations are often non-specific and do not provide much value in the diagnosis as well. Muscle biopsy can provide a definite diagnosis but is not currently recommended due to its invasiveness and association with prolonged time to symptoms resolution. Magnetic resonance imaging, in combination with classic history and risk factors can clinch the diagnosis. Treatment is generally analgesia and rest, although the former’s use may be limited in the presence of renal disease. Learning points:
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Affiliation(s)
- Punith Kempegowda
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Eka Melson
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gerald Langman
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Fady Khattar
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Muhammad Karamat
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Quratul-Ain Altaf
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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37
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Buell KG, Ajmal SR. Diabetic Myonecrosis: A Poorly Recognized Complication in an Adult With Type 2 Diabetes. Can J Diabetes 2019; 44:213-215. [PMID: 31474461 DOI: 10.1016/j.jcjd.2019.07.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/23/2019] [Accepted: 07/17/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Kevin G Buell
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
| | - Saira R Ajmal
- Division of Infectious Diseases, Advocate Christ Medical Center, Oak Lawn, Illinois, United States; Department of Internal Medicine, University of Illinois at Chicago, Chicago, Illinois, United States
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38
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Jalali Z, Sharif SK. Upper-Limb Diabetic Myonecrosis: Atypical Presentation of a Rare Complication. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1268-1272. [PMID: 31455756 PMCID: PMC6753662 DOI: 10.12659/ajcr.917030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Myonecrosis is an uncommon complication of poorly controlled diabetes, predominantly involving the lower limbs. It is an atypical presentation in the upper limbs. Here, we report a rare case with atypical involvement of the upper limbs. CASE REPORT A 53-year-old diabetic woman presented with left arm pain for the past week. She was not compliant with her medications. The patient denied any history of trauma or injection. Physical examination revealed a warm, tender, and erythematous swelling on the medial side of the left arm and was otherwise unremarkable. Her glycemic control was poor, with Hb A1C of 9.6%. Duplex ultrasonography demonstrated no evidence of fluid collection or thrombosis. An initial MRI (without contrast) report was misleadingly suggestive of polymyositis. Orthopedic consultant urged the patient to transfer to the operating room for aspiration of a probable infectious nidus, which resulted in a dry tap. Despite confusing radiological clues, ischemic myonecrosis was suspected, and second MRI studies (with contrast) reported necrosis. Tissue biopsy (the criterion standard) was withheld to avoid the risk of delayed healing or superimposed infection. Meanwhile, the patient received supportive treatment and achieved full recovery within 1 month. CONCLUSIONS Diabetic myonecrosis should be suspected in any poorly controlled diabetic patient presenting with otherwise unexplained muscle pain without any evidence of infection. Diagnosis can be made by MRI, leaving very few indications for invasive procedures. Analgesics and glycemic control are the mainstays of treatment.
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Affiliation(s)
- Zahra Jalali
- Faculty of Medicine, Tabriz University of Medical Sciences, Imam Reza Hospital, Tabriz, Iran
| | - Sakineh Khatoun Sharif
- Rheumatology Research Center, Tabriz University for Medical Sciences, Tabriz, Iran.,Department of Rheumatology, Iranian Rheumatology Association, Tehran, Iran
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39
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Diabetic myonecrosis: A case series of two dialysis-dependent patients. Clin Nephrol Case Stud 2019; 7:41-45. [PMID: 31321201 PMCID: PMC6637392 DOI: 10.5414/cncs109626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 05/03/2019] [Indexed: 11/24/2022] Open
Abstract
Diabetic myonecrosis (DMN) is a rare microangiopathic disorder that can present as an acutely painful and swollen limb in patients with established diabetes mellitus. The condition can be diagnosed noninvasively with magnetic resonance imaging and resolves with analgesia, bed rest, and glycemic control. Due to a relative lack of awareness regarding the condition, avoidable interventions such as muscle biopsies and even surgery are sometimes pursued, which have been associated with prolonged recovery times. The majority of patients with DMN have diabetic nephropathy, yet this condition is not widely recognized in the nephrology community, resulting in delayed diagnosis and patients undergoing unnecessary and potentially harmful investigations. There is therefore a need for increased awareness of the condition among renal physicians. Here, we report the cases of two patients on hemodialysis who were ultimately diagnosed with DMN, along with a review of the literature.
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40
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Galeano-Valle F, Benito-Martinez E, Álvarez-Sala-Walther L, Oprea-Ilies G, Umpierrez GE, Pasquel FJ. An atypical presentation of diabetic myonecrosis. AACE Clin Case Rep 2019; 5:e77-e81. [PMID: 31206028 DOI: 10.4158/accr-2018-0228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Diabetes myonecrosis, also called diabetic muscle infarction (DMI), is a rare complication of diabetes. Given its rarity, our understanding of the underlying causes or the optimal management of DMI cases remains unclear. Methods We report on a patient who experienced 2 episodes of DMI and we also review the literature. Results A 46-year-old male with longstanding type 2 diabetes mellitus with multiple microvascular complications presented with acute-onset painful right thigh induration. On physical examination, he had right thigh swelling, tenderness, and crepitus. Blood tests showed leukocytosis, elevated creatine phosphokinase, and elevated acute-phase reactants. Microbiological cultures were negative. Glycated hemoglobin was 6.4% (46 mmol/mol). Magnetic resonance imaging demonstrated T2 hyperintensity involving the quadriceps group. The clinical and laboratory signs suggested a muscle infection. A muscle biopsy was suggestive of DMI. Eleven months later, the patient presented again with a 4-week history of left thigh pain and weakness in both legs. On examination, he had bilateral thigh anterior tenderness without evidence of swelling or induration. He also had marked bilateral proximal motor deficiency and inability to stand or ambulate. Despite a different clinical presentation, imaging features were consistent with DMI. The patient was managed with conservative therapy. His strength improved significantly after 3 months of follow up. Conclusion The typical clinical presentation of DMI includes unilateral acute-onset pain in the quadriceps, local swelling, and the appearance of a palpable painful mass. The second episode in our patient illustrates an atypical clinical presentation of DMI and shows the importance of the correlation of clinical and imaging findings for the diagnosis of DMI.
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Affiliation(s)
- Francisco Galeano-Valle
- Department of Medicine, School of Medicine, Universidad Complutense Madrid, Spain; Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de investigaciones Sanitarias Gregorio Marañón
| | | | - Luis Álvarez-Sala-Walther
- Department of Medicine, School of Medicine, Universidad Complutense Madrid, Spain; Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Instituto de investigaciones Sanitarias Gregorio Marañón
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41
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Ganokroj P, Boonchaya-Anant P. Diabetic muscle infarction: rare complication with a distinct clinical manifestation. BMJ Case Rep 2019; 12:12/4/e228480. [PMID: 31015244 DOI: 10.1136/bcr-2018-228480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Diabetic muscle infarction is an unusual condition with distinctive clinical characteristics seen in patients with prolonged and uncontrolled diabetes. Clinical findings and imaging study are unique and challenging. Patients usually present with acute unilateral severe muscular pain and swelling, particularly in the lower extremities. The presentation is difficult to distinguish from other common conditions such as deep venous thrombosis and infectious myositis. However, early recognition of the clinical presentation and appropriate imaging selection can lead to the diagnosis and avoid unnecessary muscle biopsy. Here, we report a case of diabetic muscle infarction in a patient with poorly controlled type 1 diabetes who had a good clinical response after an early detection and appropriate treatment.
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Affiliation(s)
- Poranee Ganokroj
- Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Patchaya Boonchaya-Anant
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Excellence Center for Diabetes, Hormones and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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42
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Jevalikar G, Agarwal P, Mishra SK, Sharma J, Mithal A. Diabetic muscle infarction in type 1 and type 2 diabetes mellitus: lessons from two cases. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-019-00739-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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43
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Anupama YJ, Upadhyaya P. Diabetic Muscle Infarction: An Uncommon Cause for Acute Limb Pain in Dialysis Patients. Indian J Nephrol 2019; 29:46-49. [PMID: 30814793 PMCID: PMC6375024 DOI: 10.4103/ijn.ijn_62_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Diabetic muscle infarction (DMI) is one of the unusual complications of poorly controlled diabetes. It is usually seen in association with other microvascular complications. This condition is reported rarely, probably due to it's under recognition. It is also seen in patients with chronic kidney disease and should be considered in patients presenting with acute onset of limb pain. Here we present two cases of DMI in dialysis patients and discuss the available literature to highlight the clinical characteristics of the cases. We also present a diagnostic algorithm to discuss evaluation of dialysis patients presenting with limb pain.
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Affiliation(s)
- Y J Anupama
- Department of Nephrology, Nanjappa Hospital, Shivamogga, Karnataka, India
| | - Praveen Upadhyaya
- Department of Radiology, Nanjappa Hospital, Shivamogga, Karnataka, India
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44
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Compression of the common peroneal nerve due to peroneal muscle infarction in a patient with diabetes. Joint Bone Spine 2019; 86:265-266. [DOI: 10.1016/j.jbspin.2018.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2018] [Indexed: 10/28/2022]
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45
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Alkhoury R. A case of diabetic myonecrosis: A rare complication of a common disease. SAGE Open Med Case Rep 2019; 7:2050313X18823463. [PMID: 30719312 PMCID: PMC6349969 DOI: 10.1177/2050313x18823463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 12/14/2018] [Indexed: 11/26/2022] Open
Abstract
Diabetes mellitus is a growing concern in today’s population and a common cause of significant morbidity and mortality in those affected. Diabetic myonecrosis is an uncommon condition that can be seen in uncontrolled, long-standing diabetic patients who complain of localized, sudden-onset muscle pain. We present a 57-year-old woman with type 2 diabetes mellitus who presented to the emergency department with left-sided pelvic pain for the past 2 months. The pain had progressively gotten worse with a significant reduction in the range of motion of her left hip. Magnetic resonance imaging imaging revealed focal enhancement, edema, and enlargement of the left iliacus muscle. Assessment of serum glucose and hemoglobin A1c revealed a history of poor diabetic control, eventually giving rise to a diagnosis of diabetic myonecrosis. She was discharged with a new diabetic regimen, pain control, and outpatient physical therapy.
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46
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Gupta RD, Haobam SS, Krishna A, Ramchandran R, Satyaraddi A, Shetty S, Asha HS, Paul TV, Thomas N. Clinico-radiological characteristics and not laboratory markers are useful in diagnosing diabetic myonecrosis in Asian Indian patients with type 2 diabetes mellitus: A 10-year experience from South India. J Family Med Prim Care 2019; 7:1243-1247. [PMID: 30613504 PMCID: PMC6293897 DOI: 10.4103/jfmpc.jfmpc_4_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Diabetic myonecrosis or muscle infarction is an unusual complication of Type 2 Diabetes, usually associated with longstanding disease. It commonly presents as an acute non-traumatic palpable swelling of the affected muscle with predilection for the quadriceps and thigh muscles, often accompanied by retinopathy and nephropathy. Methodology: A retrospective review of the medical records of patients admitted with diabetic myonecrosis under the Department of Endocrinology, Christian Medical College Vellore over a period of ten years(2006-2015) was done. Data pertaining to clinical, biochemical and radiological characteristics were obtained and treatment modalities and outcomes were recorded. Results and Analysis: A total of n = 4 patients with diabetic myonecrosis and completed clinical data were included in the study. In our present series, the mean age at presentation was 45.5 years (±7.3 years), the mean duration of the diabetes was 9.0 years (±2.5 years)with an equal distribution of male and female subjects. The mean HbA1c (9.5 ± 0.6%) was suggestive of poor glycemic control at presentation with all (100%) the patients in our series having concomitant one or more microvascular complications. While laboratory parameters of elevated CPK or LDH were mostly normal, the findings of T1 hyperintense and T2 hypointense heterogenous lower limb lesions were present in all the subjects (n = 4). Conservative management with bed rest, analgesics and good glycemic control were effective in good clinical improvement over a period of 1-2 months. Conclusions: Our series of diabetic myonecrosis in Indian patients with Type 2 diabetes mellitus, elucidates the varied clinical presentations, with MRI findings rather than laboratory markers being the mainstay of diagnosis.
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Affiliation(s)
- Riddhi Das Gupta
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Surjit Singh Haobam
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anish Krishna
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Roshna Ramchandran
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anil Satyaraddi
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shrinath Shetty
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - H S Asha
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Thomas V Paul
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
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Verjee MA, Abdelsamad NA, Qureshi S, Malik RA. Diabetic muscle infarction: often misdiagnosed and mismanaged. Diabetes Metab Syndr Obes 2019; 12:285-290. [PMID: 30881071 PMCID: PMC6408199 DOI: 10.2147/dmso.s185839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A patient with type 2 diabetes, retinopathy, neuropathy, and nephropathy presented with severe right distal thigh pain, which awoke him from sleep. He was diagnosed with musculoskeletal pain and discharged home. Two days later, the severity of pain increased in his right thigh and, subsequently, he developed pain in the proximal lateral aspect of his left thigh, for which he returned to hospital. He had elevated creatine kinase and myoglobin levels. An ultrasound of the right thigh identified a loss of definition of the normal muscular striations and subcutaneous edema. On MRI, the axial STIR image demonstrated extensive T2 hyperintensity in the right vastus medialis and left vastus lateralis, consistent with the diagnosis of diabetic muscle infarction (DMI). This presentation emphasizes the need for a thorough patient history and physical examination, and the importance of directed imaging for the prompt diagnosis of DMI.
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Affiliation(s)
- Mohamud A Verjee
- Department of Paediatrics, University of Utah, Salt Lake City, UT 84112, USA
- Correspondence:, Mohamud A. Verjee, Family Medicine in Clinical Medicine, Weill Cornell Medicine, P.O. Box 24144, Qatar Foundation, Education City, Doha, Qatar, Tel +974 4492 8504, Fax +974 4492 8555, Email
| | | | - Salman Qureshi
- Department of Radiology, University of Manchester, Manchester M13 9PL, UK
- Department of Radiology, Hamad Medical Corporation, Doha, Qatar
| | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine – Qatar, Qatar Foundation, Education City, Doha, Qatar,
- Institute of Cardiovascular Medicine, University of Manchester, Manchester, M13 9PL, UK
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48
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Ivanov M, Asif B, Jaffe R. Don't Move a Muscle: A Case of Diabetic Myonecrosis. Am J Med 2018; 131:e445-e448. [PMID: 30055124 DOI: 10.1016/j.amjmed.2018.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 07/01/2018] [Accepted: 07/03/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Margaret Ivanov
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pa.
| | - Bilal Asif
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Rebecca Jaffe
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pa
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49
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Diabetic Myonecrosis: A Diagnostic and Treatment Challenge in Longstanding Diabetes. Case Rep Endocrinol 2018; 2018:1723695. [PMID: 30159176 PMCID: PMC6109525 DOI: 10.1155/2018/1723695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/02/2018] [Indexed: 11/17/2022] Open
Abstract
Objective Diabetes mellitus is associated with microvascular and macrovascular complications; the most commonly recognized ones include diabetic nephropathy, retinopathy, and neuropathy. Less well-known complications are equally important, as timely recognition and treatment are essential to decrease short- and long-term morbidity. Methods Herein, we describe a case of a 41-year-old female with longstanding, uncontrolled type 2 diabetes, who presented with classical findings of diabetic myonecrosis. Results Our patient underwent extensive laboratory and imaging studies prior to diagnosis due to its rarity and similarity in presentation with other commonly noted musculoskeletal conditions. We emphasize the clinical presentation, laboratory and imaging findings, treatment regimen, and prognosis associated with diabetic myonecrosis. Conclusion Diabetic myonecrosis is a rare complication of longstanding, poorly controlled diabetes mellitus. The diagnosis requires a high index of suspicion in the right clinical setting: acute onset nontraumatic muscular pain with associated findings on clinical exam, laboratory studies, and imaging. While the short-term prognosis is good, the recurrence rate remains high and long-term prognosis is poor given underlying uncontrolled diabetes and associated sequelae.
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50
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Kim YJ, Lee KA, Park TS, Jin HY. VISUAL VIGNETTE. Endocr Pract 2018; 25:292. [PMID: 30084675 DOI: 10.4158/ep-2018-0343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yu J Kim
- From the Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical School, Research Institute of Clinical Medicine of Chonbuk National University - Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, South Korea
| | - Kyung A Lee
- From the Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical School, Research Institute of Clinical Medicine of Chonbuk National University - Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, South Korea
| | - Tae S Park
- From the Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical School, Research Institute of Clinical Medicine of Chonbuk National University - Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, South Korea
| | - Heung Y Jin
- From the Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical School, Research Institute of Clinical Medicine of Chonbuk National University - Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, South Korea
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