Diabetic myonecrosis: An unusual complication of Type 1 Diabetes Mellitus in a 49-year-old male patient. Case report.

Abstract

Diabetic myonecrosis (DMN) is an uncommon complication of uncontrolled Diabetes Mellitus (DM), resulting from microvascular changes that lead to ischemia and tissue necrosis. The objective of this study is to describe the clinical manifestations, diagnosis, and treatment of DMN through a case report. A 49-year-old male patient with poorly controlled type 1 DM with a 28-year history of the disease, presented with pain and swelling in his left thigh. Ultrasound revealed inflammation of the quadriceps femoris, suggesting pyomyositis. However, after two months without improvement despite multiple antibiotic regimens, magnetic resonance imaging (MRI) was ordered. The MRI showed no abscesses but rather a large inflammatory process with interstitial fluid visualized as hyperintense on T2-weighted images, establishing the diagnosis of DMN. He was treated with anti-inflammatory drugs, analgesics, glycemic control, and physical therapy. There was an initial favorable clinical course; however, he died eight months later from complications of distal penile necrosis and sepsis. DMN is more prevalent in women; it is unilateral in most cases, and it is often accompanied by microvascular complications. Clinical suspicion and magnetic resonance imaging (MRI) lead to an accurate diagnosis. Treatment focuses on analgesia, glycemic control, and rest. The short-term prognosis is favorable, although life expectancy does not exceed five years due to the high incidence of recurrence and death from vascular complications. Physicians should be made aware of this unusual condition and adopt a multidisciplinary approach for timely diagnosis and treatment.