Diabetic Muscle Infarction: A Systematic Review
Abstract Context Diabetic muscle infarction (DMI) is a rare complication associated with poorly controlled diabetes mellitus. Less than 200 cases have been reported in the literature since it was first described over 45 years ago. There is no clear ‘standard of care’ for managing these patients. Evidence acquisition PubMed searches were conducted for ‘diabetic muscle infarction’ and ‘diabetic myonecrosis’ from database inception through July 2014. All articles identified by these searches were reviewed in detail if the article text was available in English. Evidence synthesis The current literature exists as case reports or small case series, with no prospective or higher-order treatment studies available. Thus, an evidence-based approach to data synthesis was difficult. The available literature is presented objectively with an attempt to describe clinically relevant trends and findings in the diagnosis and management of DMI. Conclusions Early recognition of DMI is key, so appropriate treatment can be initiated. MRI is the radiological study of choice. A combination of bed rest, glycemic control, and non-steroidal anti-inflammatory drug therapy appears to yield the shortest time to symptom resolution and the lowest risk of recurrence. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: View Full Text Continue reading >>
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The Effect Of Korean Medical Treatment On Suspected Diabetic Muscle Infarction (dmi)
The Effect of Korean Medical Treatment on Suspected Diabetic Muscle Infarction (DMI) Park, Lee, Baek, Yang, and Ahn: The Effect of Korean Medical Treatment on Suspected Diabetic Muscle Infarction (DMI) DOI: The Effect of Korean Medical Treatment on Suspected Diabetic Muscle Infarction (DMI) 1Dept. of Acupuncture & Moxibustion Medicine, Samse Korean Medical Hospital 2Dept. of Acupuncture & Moxibustion Medicine, College of Oriental Medicine, Sang-Ji University *Corresponding author: Department of Acupuncture & Moxibustion Medicine, Samse Korean Medical Hospital, 1580 Jungangdaero, Geumjeong-gu, Busan, 46302, Republic of Korea, Tel: +82-51-580-6956, E-mail: [email protected] Received October 04, 2016 Revised November 23, 2016 Accepted November 29, 2016 Copyright 2016 KAMMS. Korean Acupuncture & Moxibustion Medicine Society. All rights reserved. This study reports the clinical effects of Korean medical treatment on a patient with suspected diabetic muscle infarction (DMI). A patient diagnosed with spinal stenosis was suspected of DMI. The patient was treated with acupuncture, bee-venom pharmacopuncture and gastrocnemius stretching. Symptoms were evaluated by verbal numeric rating scale (vNRS), Oswestry disability index (ODI) and Manchester foot pain and disability index (MFPDI). After approximately 5 weeks of Korean medical treatment, including 8 bee-venom treatments, vNRS, ODI, and MFPDI all decreased. Key Words: Diabetic muscle infarction ; Bee Venom ; Korean medicine . On October 2015, Statistics Korea announced healthcare payments status from 2010 to 2014, categorized by the Korean standard classification of disease (KCD). According to the statistics, Korean medical treatments for diseases of the musculoskeletal system and connective tissue steadily increased [ 1 ]. As Continue reading >>
Diabetic Muscle Infarction: A Rare Complication Of Long-standing And Poorly Controlled Diabetes Mellitus
Diabetic Muscle Infarction: A Rare Complication of Long-Standing and Poorly Controlled Diabetes Mellitus Shridhar N. Iyer ,1 Almond J. Drake III ,2 R. Lee West ,3and Robert J. Tanenberg 2 1Division of General Internal Medicine, Department of Internal Medicine, The Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA 2Division of Endocrinology, Department of Internal Medicine, The Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA 3Department of Pathology, The Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA Received 9 July 2011; Accepted 8 August 2011 Copyright 2011 Shridhar N. Iyer et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. To report a case of diabetic muscle infarction (DMI), a rare complication of long-standing poorly controlled diabetes mellitus. Methods. We describe a case of a 45-year-old male with an approximately 8-year history of poorly controlled type 2 diabetes mellitus with multiple microvascular complications who presented with the sudden onset of left thigh pain and swelling. He had a swollen left thigh and a CK of 1670 U/L. He was initially treated with intravenous antibiotics for a presumptive diagnosis of pyomyositis or necrotizing fasciitis with no improvement. A diagnosis of diabetic muscle infarction was considered. Results. An MRI of the thigh demonstrated diffuse edema in the anterior compartment. A muscle biopsy demonstrated coagulation necrosis in skeletal muscle and inflammation and infarction in the walls of small blood vessels. These studies confirmed the final diagnosis of D Continue reading >>
Diabetic Muscle Infarction In A 57 Year Old Male: A Case Report
Diabetic muscle infarction in a 57 year old male: a case report Litvinov et al.; licensee BioMed Central Ltd.2012 Diabetic muscle infarction is a rare complication of diabetes mellitus (DM) and is often misdiagnosed as cellulitis. This complication is usually associated with poor disease prognosis and high mortality with previous studies reporting a risk of 50% recurrence or another macrovascular complication occurring within one year. Thus, there needs to be greater awareness of this complication of diabetes. In the current work, we present a case report and literature review of DMI occurring in a calf of a 57 year old male. However, unlike the suspected trend, our patient has performed well after this incident and has not sustained another macrovascular event now > 15 month since his original diabetic muscle infarction. Even though diabetic muscle infarction is an uncommon condition, it is important to consider this diagnosis in a diabetic patient. We hope that our findings and literature review will aid clinicians to better diagnose and manage this condition. Diabetic muscle infarctionDiabetic myonecrosis Diabetic muscle infarction (DMI), also known as diabetic myonecrosis, is a rare complication of diabetes mellitus (DM) and is usually associated with poor disease prognosis and high mortality[ 1 , 2 ]. It is often defined as spontaneous ischemic necrosis of skeletal muscle that is unrelated to atheroembolism or occlusion of major arteries[ 2 , 3 ]. The exact prevalence of this condition is not known. A systematic review of the literature from inception to August 2001 identified at total 47 reports describing 166 episodes of DMI[ 2 ]. Usually this condition develops with approximate equal frequency in males and females[ 1 , 2 ]. Established risk factors for acquirin Continue reading >>
Magnetic Resonance Imaging Of Diabetic Muscle Infarction: Report Of Two Cases
Magnetic Resonance Imaging of Diabetic Muscle Infarction: Report of Two Cases We are experimenting with display styles that make it easier to read articles in PMC. The ePub format uses eBook readers, which have several "ease of reading" features already built in. The ePub format is best viewed in the iBooks reader. You may notice problems with the display of certain parts of an article in other eReaders. Generating an ePub file may take a long time, please be patient. Magnetic Resonance Imaging of Diabetic Muscle Infarction: Report of Two Cases Anugayathri Jawahar, DNB and Ravikanth Balaji, DMRD, DNB Diabetic muscle infarction (DMI) occurs as a rare complication of long standing or severe diabetes mellitus. The condition usually occurs spontaneously and patients usually present with acute pain and swelling of affected muscles which persists for weeks, and resolves spontaneously without intervention. Magnetic resonance (MR) imaging is the modality of choice in patients with suspected DMI based on appropriate clinical setting and plays a major role in the diagnosis, assessing the extent of involvement and differentiating DMI from other conditions. The DMI affected muscles are bulky and appear heterogeneous with hyperintense signals on T2-weighted and STIR sequences, hypo or isointense on T1-weighted images with loss of normal fatty intramuscular septae. Subcutaneous and perifascial edema can be present. On postgadolinium scans, there is diffuse heterogeneous enhancement with non-enhancing foci, which may represent areas of necrosis. Biopsy can be avoided as MR findings are highly sensitive and specific. Treatment is usually conservative. Surgical intervention is required only in patients who do not respond to conservative management. The common differential diagnosis inc Continue reading >>
Risking Life And Limb: A Case Of Spontaneous Diabetic Muscle Infarction (diabetic Myonecrosis)
Risking Life and Limb: A Case of Spontaneous Diabetic Muscle Infarction (Diabetic Myonecrosis) 1grid.266539.d0000000419368438Department of Internal Medicine, University of Kentucky, Lexington, KY USA 2grid.214572.70000000419368294Department of Allergy and Immunology, Department of Rheumatology, University of Iowa, Iowa City, IA USA 3Department of Internal Medicine, K521 Kentucky Clinic, 740 South Limestone Street, Lexington, KY 40536 USA David Rudy, Phone: (859) 229-2748, Email: ude.yku.liame@0ydurwd . Copyright Society of General Internal Medicine 2015 Diabetic muscle infarction, also known as diabetic myonecrosis, is a microvascular complication of poorly controlled diabetes mellitus characterized by unilateral limb pain and swelling. Because these symptoms closely mimic cellulitis and thromboembolism, diagnosis is often delayed or missed altogether, leading to increased morbidity and inappropriate treatment. We describe a case of unilateral limb pain and swelling due to diabetic muscle infarction in a 36-year-old patient with poorly controlled diabetes mellitus. We also review the literature on the diagnosis, prognosis, and management of this under-recognized condition. KEY WORDS: diabetes, muscle infarction, leg pain Leg pain is a common complaint among patients with diabetes mellitus, and is frequently assessed in the ambulatory, emergency, and inpatient settings. Due to its nonspecific presentation, diagnosis is hard to establish, often leading to delayed diagnosis, under-treatment, and excessive laboratory and radiographic testing. Diabetic muscle infarction is a rare cause of leg pain but is likely under-recognized in patients with complication of long-standing, poorly controlled diabetes mellitus. We present a case of a 31-year-old woman presenting with unilat Continue reading >>
Diabetic Muscle Infarction: An Unrecognised Complication Of Diabetes - A Case Report From Subhimalayan Region Of India Mokta Jk, Mokta K, Panda Pk, Bhatia V - Indian J Endocr Metab
Diabetic muscle infarction (DMI) is an unknown complication of poorly controlled long standing diabetes. Presentation, though is well characterised with sudden onset of painful swelling, mostly of the thigh without history of trauma or features of infections. The differential diagnosis is extensive and it is frequently misdiagnosed clinically and treated as polymyositis, pyomyositis and rhabdomyolysis. The uniform clinical presentation and characteristic T2 weighted imaging is sufficient to make the timely diagnosis of DMI and excluding other clinical entities, thus avoiding unnecessary investigations and interventations. [1] An-81- year old diabetic female presented with severe pain and swelling of left thigh in the emergency department in January, 2011. The previous night she woke up suddenly because of the severe pain in her left thigh. The pain was so severe that she couldn't touch her thigh nor could she move it. She denied having any other symptoms. On examination, she was a febrile with pulse rate of 90 beats/min; respiratory rate of 16 breath/min and blood pressure was 160/100 mmHg. Systemic examination of chest, heart and abdomen was also normal. On local examination left thigh was swollen with difference of 12 cm between left and right, indurated and was excruciatingly tender to touch, maximum on anterolateral aspect without any erythema and cellulitis but was warmer than right thigh. Funds examination showed hypertensive along with background diabetic retinopathy changes. Peripheral pulses were symmetrical. There were no muscle fasciculations, muscle atrophy and tenderness of the spine. There was no evidence of neurovascular compromise. Neurological examination revealed absent ankle reflexes and absent vibration sensation at big toe and ankle bilaterally. He Continue reading >>
Diabetic Myonecrosis
1. Chew FS. Skeletal Radiology. Lippincott Williams & Wilkins. (2010) ISBN:1608317064. Read it at Google Books - Find it at Amazon 2. Choudhury BK, Saikia UK, Sarma D et-al. Diabetic myonecrosis: An underreported complication of diabetes mellitus. Indian J Endocrinol Metab. 2011;15 (5): S58-61. doi:10.4103/2230-8210.83052 - Free text at pubmed - Pubmed citation 3. Sran S, Sran M, Ferguson N et-al. Diabetic myonecrosis: uncommon complications in common diseases. Case Rep Endocrinol. 2014;2014: 175029. doi:10.1155/2014/175029 - Free text at pubmed - Pubmed citation 4. Hoyt JR, Wittich CM. Diabetic myonecrosis. J. Clin. Endocrinol. Metab. 2008;93 (10): 3690. doi:10.1210/jc.2008-0416 - Pubmed citation 5. Kattapuram TM, Suri R, Rosol MS et-al. Idiopathic and diabetic skeletal muscle necrosis: evaluation by magnetic resonance imaging. Skeletal Radiol. 2005;34 (4): 203-9. doi:10.1007/s00256-004-0881-8 - Pubmed citation 6. May DA, Disler DG, Jones EA et-al. Abnormal signal intensity in skeletal muscle at MR imaging: patterns, pearls, and pitfalls. Radiographics. 2000;20 Spec No (suppl_1): S295-315. doi:10.1148/radiographics.20.suppl_1.g00oc18s295 - Pubmed citation 7. Bhasin R, Ghobrial I. Diabetic myonecrosis: a diagnostic challenge in patients with long-standing diabetes. J Community Hosp Intern Med Perspect. 2013;3 (1): . doi:10.3402/jchimp.v3i1.20494 - Free text at pubmed - Pubmed citation Continue reading >>
Diabetic Muscle Infarction
Richard J MacIsaac, George Jerums and Lisa Scurrah A 55-year-old woman with type 2 diabetes of 8 years' duration experienced, over 23 days, the onset of pain, tenderness and swelling of the medial aspect of her right thigh. She had recently commenced insulin therapy and was displaying good glycaemic control (HbA1c level of 6.4%). She had diabetic complications of autonomic and peripheral neuropathy, but no retinopathy. Other medical problems included chronic renal impairment, hypertension, polyarticular gout and hydralazine-induced lupus. A renal biopsy had not been performed, but her renal insufficiency was believed to be a result of diabetic nephropathy and hypertension. She was taking twice-daily mixed insulin (16 units in the morning and 10 units at night), felodipine (10 mg/day), paroxetine (10 mg/day), allopurinol (75 mg/day) and prednisolone (7.5 mg/day). Her serum creatinine level had peaked at 0.31 mmol/L, but stabilised at 0.21 mmol/L after cessation of an angiotensin-converting enzyme inhibitor. A 24-hour urine collection showed a creatinine clearance rate of 0.12 mL/s (normal range [NR], 1.52.5 mL/s) and a protein excretion rate of 4.6 g/day. Renal duplex ultrasound showed that her kidney size was well preserved, but there was a suggestion of renal artery stenosis on the right side. There was no history of recent injury or injection to her thigh. She had not experienced any rigors and was afebrile. The area of the localised, tender swelling on the medial aspect of her right thigh was not erythematous and no local lymphadenopathy was noted. Apart from the thigh swelling, there was generalised wasting and weakness of the lower limbs, loss of ankle reflexes, and loss of sensation in a stocking distribution, consistent with a diagnosis of peripheral neuropathy. Continue reading >>
Non-traumatic Muscle Pain In A Diabetic
Monalisa Mullick, MD¹, Cheryl McDonough, MD² INTRODUCTION The prevalence of diabetes in the adult population in United States is approximately 10% and is expected to rise. The myriad of complexities of this entity, both microvascular and macrovascular is anticipated to follow suit, adding to the morbidity and mortality. Diabetic muscle infarction (DMI) is one such incompletely understood complication of long-standing uncontrolled diabetes and seems to play a crucial role in risk stratification in those with microvascular involvement. DMI has shown to be a poor prognosticator of long-term survival, a grim reality given the mean age of presentation is only 43 years. Further investigation into improving this outlook and whether tighter glycemic control changes outcome would be of significant interest and benefit. CASE PRESENTATION A 24-year-old male with hypertension and twenty-year history of uncontrolled type I diabetes was admitted with two months of pain near the right knee, acutely worsening over one week. Right knee effusion was recently diagnosed with synovial fluid twice negative for infection or crystals. He denied fever, chills, weight loss, trauma, injecting insulin in the area, or illicit drug use. Lower extremity paresthesias were chronic. He previously had a toe amputated due to osteomyelitis. On exam, he was afebrile. Right knee had a small effusion but was without associated redness or pain. An area of significant tenderness to palpation with no erythema, warmth, swelling, or mass was present on the right medial thigh just proximal to the knee. Electrolytes, renal function, leukocyte count and differential, and coagulation profile were normal. Blood glucose was 457 with glycosylated hemoglobin of 17. Synovial fluid was minimally inflammatory. Doppler was Continue reading >>
Radiological Case: Diabetic Myonecrosis
A 51-year-old woman presented to the emergency room with spontaneoussevere left thigh pain and mild left thigh swelling. Significant medicalhistory included uncontrolled diabetes mellitus, coronary arterydisease with stent placement, hyperlipidemia, and hypertension.Thepatient denied recent trauma or intramuscular injections. The patientslaboratory findings included a normal CBC; elevated glucose of454 mg/dl;elevated Hgb A1c of 16.4%; and a normal CK level of 70 u/l. A venousultrasound taken upon admission was negative for deep vein thrombosis(DVT). The patient was placed on antibiotic therapy for suspectedcellulitis with no clinical improvement. A magnetic resonance imaging(MRI) scan was subsequently obtained. As a ligament injury was suspected, T2-weighted images (Figure 1)showed extensive intramuscular fluid within the adductor and hamstringmuscle groups, and intramuscular edema within the quadriceps muscle.Diffuse fascial edema and subcutaneous soft-tissue edema was also noted.T1-weighted, postcontrast images (Figures 2 and 3) showed intensemuscular rim enhancement outlining areas of muscle necrosis within theadductor and hamstring muscle groups. Posterior ankle impingement syndrome due to os trigonum syndrome Diabetic myonecrosis, or diabetic muscle infarct (DMI), is anuncommon and underdiagnosed complication of diabetes mellitus(DM). DMIis generally self-limiting, requiring only conservative treatment.However, failure to recognize this condition can result insignificantmorbidity. DMI is often misdiagnosed as abscess, myositis, necrotizingfasciitis, or neoplasm.1 DMI should be considered in the differential of acute muscle pain in patients with DM. First described in 1965, DMI is often seen in longstanding diabetics.A significant proportion of patients are noncomp Continue reading >>
Recurrent Diabetic Muscle Infarction, A Rare Complication Of Diabetes: A Case Report Bhat T, Naik M, Mir Mf, Singh J, Shah A - Egypt Rheumatol Rehabil
Diabetic muscle infarction is a rare complication of diabetes mellitus that presents as a localized, exquisitely painful swelling and limited range of motion of the involved extremity. The onset is usually acute, persists for several weeks and resolves spontaneously over several weeks to months without the need for intervention. However, as diabetes mellitus is an immunocompromised state and any painful swelling in the limbs is often taken as infectious in aetiology, the patient is inadvertently investigated with invasive procedures and is started on unnecessary antibiotics, adding to the burden of management. Keeping in view the low threshold for starting antibiotics in painful limb swelling in diabetes mellitus in our setting, we hereby describe a case of recurrent painful diabetic muscle infarction, first involving the right upper and later the right lower limb, managed with physical rest and analgesics. This case emphasizes that the treating physician keep this rare complication of diabetes mellitus in consideration in the respective clinical scenario and adopt a less aggressive (a noninvasive method like ultrasound) rather than a more aggressive (an invasive method like muscle biopsy) approach in diagnosis and take a similar approach towards management. Keywords:diabetes mellitus, diabetic muscle infarction, diabetic myonecrosis Bhat T, Naik M, Mir MF, Singh J, Shah A. Recurrent diabetic muscle infarction, a rare complication of diabetes: a case report. Egypt Rheumatol Rehabil 2017;44:181-4 Bhat T, Naik M, Mir MF, Singh J, Shah A. Recurrent diabetic muscle infarction, a rare complication of diabetes: a case report. Egypt Rheumatol Rehabil [serial online] 2017 [cited2018 Apr 29];44:181-4. Available from: Diabetic muscle infarction (DMI) is a rare cause of acute sev Continue reading >>
Painful Swelling Of The Thigh In A Diabetic Patient: Diabetic Muscle Infarction
The occurrence of a painful, inflammatory swelling in a lower limb is consistent with several diagnoses, such as deep vein thrombosis, compartment syndrome, muscle rupture, soft tissue infection, haemorrhagic or neoplastic processes, myositis, pyomyositis, etc. In the diabetic patient, an unusual diagnosis should be added to this list, i.e. so-called diabetic muscle infarction (DMI). Skeletal muscle infarction is a rare condition occurring specifically in the diabetic patient. Accurate management of DMI depends mainly on the physician's awareness of this condition, which can avoid unnecessary or potentially hazardous investigations and delayed or inadequate treatment. We report a case of DMI in a diabetic woman and a review of 43 previous cases in the literature. Clinical report A 44-year-old woman was hospitalised because of painful swelling of her right thigh. As her thinking was somewhat disturbed, the date of symptom onset remained uncertain. On the day of admission, she complained of continuous severe pain in the anterior right thigh and was unable to walk. The anteromedial distal part of her thigh was enlarged, diffusely firm, tender and warm, with an ill-defined oval mass in the vastus medialis and/or adductor muscles. The knee showed joint effusion but was otherwise normal and free of pain. There was moderate oedema of the left leg without signs of thrombophlebitis. The patient was thin but not febrile and denied any history of trauma or abnormal exercise. She had a history of Type 1 diabetes mellitus diagnosed 5 years earlier, which was poorly controlled because of a lack of compliance with follow-up and treatment. Admission laboratory tests showed fasting blood glucose (19 mmol/l) and moderate acidosis (pH 7.33, bicarbonates 18 mmol/l). The erythrocyte sedimen Continue reading >>
Diabetic Muscle Infarction Mri Ezine Articles
Diabetic Muscle Infarction Mri Ezine Articles CALIFORNIA DIABETES & PREGNANCY PROGRAM 1 Insulin Analogs in Pregnancy. What is advanced pancreatic cancer? If you inject into thigh always use thigh. Diabetic Muscle Infarction Mri Ezine Articles seu pet sente muita sede muita mesmo! tem feito Mas para quem no sabe Prevalence & determinants of depression in type 2 diabetes patients available data regarding the prevalence of depression in type 2 diabetes (T2DM) WHAT CAN YOU EAT WITH DIABETES ] The REAL pleasure of eating and also avoid complications in type 2 diabetes. EASY TOUCH OWNERS MANUAL maintenance guide you need to know Diabetic Muscle Infarction Mri Ezine Articles detail regarding your products cause this manual for download glucose monitoring system site low-cost sensor Diabetic Muscle Infarction Mri Ezine Articles systems integrated DexCom is racing to create a CGM product thats viable for the Step by step recipe for making Homemade Raspberry Jam Using Honey! So one of these is the honey jam and one of these is the sugar. While cinnamon may be used for diabetes it is also known to be effective for treating flatulence Diabetic Diet Vegetables accu-chek home inspection causes diabetes best food products Diabetic Muscle Infarction Mri Ezine Articles for Accessories; Gift of Hope. Diabetes Emergency help please or..semi emergency Im a type I diabetic..I usually inject insulin at around 7 pm every night but my levels have been During the period from the 28th to the 30th week Glucose in the urine also may be the first sign that a person has diabetes mellitus however; When Was Diabetes First Discovered :: Shoes For Diabetic Patients The 3 Step Trick that Reverses Diabetes Permanently in As Little as 11 Days. Coding CliniC update August and diabetes mellitus are chronic Continue reading >>
Jcdr - Muscle Infarction, Diabetes Mellitus, Thigh Swelling, Sonography, Mri
Muscle infarction, Diabetes mellitus, Thigh swelling, Sonography, MRI Suhith Gajanthodi, Rakesh Rai, Rajeev Kumar Chaudhry. DIABETES MUSCLE INFARCTION:A CASE STUDY. Journal of Clinical and Diagnostic Research [serial online] 2012 May [cited: 2018 May 27 ]; 6:455-456. Available from A 58-year-old man with a 22-year history of type 2 diabetes mellitus(DM) presented with sudden and spontaneous onset of right anteromedial thigh pain and swelling. He also gave history of chronic kidney disease since 3-years. On examination, firm swelling on the right medial aspect of thigh measuring 10 5 cm with area of induration, erythema, warmth, and tenderness was revealed (Table/Fig 1) . Patient also had restricted movement around the right knee joint. Peripheral pulses were palpable with no bruits. Laboratory data showed white blood cell count of 10.8109/l (normal range 4.0-11.0), with a normal eosinophil count, low haemoglobin of 8.4 g/l (12-16), normal platelets of 371109/l (normal range 150-400) and raised erythrocyte sedimentation rate of 78 mm/hr (normal range 10-20). serum creatinine at 6.8mg/dl (0.5-1.5), electrolytes were normal, with a serum potassium of 4.4 mmol/l. Glycated haemoglobin was 7.7%. Creatine kinase was 428 U/l (0-190 U/l), Urinalysis showed 3.0 g/l of protein (normal negative). Ultrasonography of the right thigh revealed altered echo-texture with hyperechoic areas within the vastus medialis along the lower third of thigh. Superficial and deep veins were normal. Magnetic resonance imaging showed increased signal intensity on T2-weighted images of his right quadriceps, with diffuse subcutaneous and fat edema. There was extensive swelling of the quadriceps, vastus medialis and rectus with inter-muscular edema (Table/Fig 2) . He was treated with intravenous antibiot Continue reading >>
