Dr LUKE ARMOUR1,2, Dr HARI NANDAKOBAN1,2, Dr JEFFREY WONG1,2
1department of nephrology, liverpool, australia, 2south western sydney clinical school, university of new south wales, Sydney, Australia
Introduction: Diabetic myonecrosis is a rare microvascular complication of diabetes. It presents with acute or subacute pain and swelling to the affected limb secondary to ischaemic necrosis of skeletal muscle. It is commonly associated with other microangiopathic complications of diabetes including nephropathy, retinopathy and neuropathy. The most common site of involvement is the thigh, followed by the distal lower limb.
Aims: To describe a case series of patients presenting with diabetic myonecrosis to our tertiary centre.
Methods: A total of five patients were identified from renal department consultant records from the Renal Unit records with diabetic myonecrosis from 2017-2022. Patient demographics and details regarding diabetes and control (Hba1c), associated complications and region of diabetic myonecrosis was gathered.
Results: All five patients had type 2 diabetes mellitus with a Hba1c between 6-8% however had evidence of previously poor control with Hba1c levels greater than 10%. Two patients were on haemodialysis, one on peritoneal dialysis, one was a renal transplant recipient and the other a stage IV CKD patient. The most common complications of diabetes in addition to nephropathy were peripheral vascular disease (3 out of 5), and retinopathy (2 out of 5). Three patients were on insulin therapy in addition to oral glucose lowering therapy. 4 out of the 5 patients presented with acute/subacute unilateral thigh pain. Creatine kinase levels were only modestly elevated and only one patient had a muscle histology consistent with myonecrosis.
Conclusions: Patients had features of previously poorly controlled diabetes with significantly elevated Hba1c and other microvascular disease. Nearly all cases presented as unilateral thigh pain and creatine kinase as well as muscle biopsy were often non-contributory to the diagnosis.
Biography:
Basic Physician Trainee at Liverpool Hospital with strong interest in nephrology