Thank you Dr. Jane Ma for a a great presentation of a woman with right thigh pain and swelling, found to have diabetic myonecrosis

Teaching Points: 

• Rare complication associated with poorly-controlled DM caused by infarcted muscle tissue
• Acute pain and swelling of the affected muscle, most often in the lower extremities (most commonly in the thigh, second most common is calf pain/swelling)
• Usually no history of trauma or fever
• Usually in patients with poor glycemic control and complications of that (nephropathy, retinopathy, neuropathy)
• MRI: imaging study of choice
• Must rule out infectious causes, often with a CT-guided biopsy (ie. pyomyositis)
• Muscle biopsy: can give you a definitive diagnosis but not currently recommended due to risks of complications from procedure and increase in time to recovery
• Management: Conservative: Rest, pain control, NSAIDs