Diabetic muscle infarction.

A 52-year-old woman was admitted for initiation of hemodialysis. She had a 33year history of type 1 diabetes mellitus complicated by diabetic nephropathy, retinopathy, peripheral neuropathy, and gastroparesis. She developed acute right medial thigh pain and swelling, which prevented her from walking. The medial aspect of the thigh was firm, edematous, and exquisitely tender, but without warmth, erythema, or fluctuance. The distal leg was normal and neuromuscular function was intact. Venous duplex examination did not reveal evidence of venous thrombosis. Ultrasound of the medial thigh demonstrated a hypoechoic area in the adductor compartment, but no material could be aspirated. Laboratory studies were notable for a white blood cell (WBC) count of 9800 per mL3 and an erythrocyte sedimentation rate (ESR) of 79 mm per hour. Magnetic resonance imaging (MRI) of the right thigh demonstrated edema of the adductor muscle group and overlying subcutaneous tissue. A focal area of brighter signal in the adductor brevis suggested a mass. The clinical and radiographic findings were consistent with diabetic muscle infarction (DMI). Pain medication and bed rest were initiated, followed by physical therapy. The right leg pain gradually improved over the next month. Repeat MRI showed resolution of the mass-like area and decreased edema.