Idiopathic Necrosis of Skeletal Muscle in Patients Who Have Diabetes. Report of Four Cases and Review of the Literature

Infarction of skeletal muscle in patients who have diabetes is an infrequently recognized clinicopathological entity1-17. Most of the reports on this condition have appeared in journals and textbooks on internal medicine and radiology. Radiographically, the lesion may be misinterpreted as a soft-tissue sarcoma or infection, in which case the patient may be referred to an orthopaedic surgeon. The mean age of the four patients reported on here was forty-two years (range, twenty-eight to fifty-nine years). The patients had sought medical attention because of an exquisitely tender swelling of the anterior aspect of the thigh, which had been present for ten days to four weeks before the initial evaluation. Two patients had a history of insulin-dependent diabetes, one had a history of non-insulin-dependent diabetes, and one was diagnosed with diabetes at the time of the initial evaluation. Three patients had no evidence of recurrence after a mean duration of follow-up of thirty-one months (range, twenty-four to forty-two months). The fourth patient had recurrence of the muscular necrosis and died six months later as a result of diabetic complications. CASE 1. A fifty-nine-year-old white man who had insulin-dependent diabetes mellitus was seen because of a three-week history of swelling of the distal two-thirds of the right thigh. The swelling had decreased during the week before the evaluation, leaving an exquisitely tender palpable mass. The patient had a twelve-year history of diabetes mellitus and had used thirty-five units of neutral protamine Hagedorn insulin each day for ten years. He had diabetic retinopathy and neuropathy but no evidence of nephropathy. He also had hypertension and coronary artery disease. Physical examination revealed an extremely tender mass, eight by five centimeters, in the anteromedial aspect of the distal part of the right thigh. Mild swelling was observed in the region of the …