Diabetic muscle infarction (DMI) is a frequently misdiagnosed, rare event complicating poorly controlled diabetes. It typically presents with acute, unilateral pain and swelling of the leg. We report a patient diagnosed as having DMI by the dermatology consultation service after that service was called to evaluate for nephrogenic systemic fibrosis (NSF) in a patient with diabetic nephropathy undergoing hemodialysis.
A 51-year-old man undergoing hemodialysis for diabetic nephropathy was admitted for left thigh pain and subjective fevers for several weeks. He had been treated the previous month with vancomycin and amikacin for a polymicrobial fistula infection. He had no history of recent trauma. On admission, he was afebrile. The medial left thigh was tender to deep palpation with an ill-defined masslike swelling and induration (Figure 1) but minimal overlying erythema. No pitting edema was present.
MacGregor JL, Chan P, Schneiderman PI, Grossman ME. Diabetic Muscle Infarction. Arch Dermatol. 2007;143(11):1447-1462. doi:10.1001/archderm.143.11.1456