Novel case of diabetic myonecrosis in a teenage patient with type 2 diabetes mellitus

Abstract

Diabetic myonecrosis is a rare complication of diabetes that is typically described in patients with long-standing, uncontrolled diabetes. We report a case in which diabetic myonecrosis presents as an early complication of diabetes. To our knowledge, this is the first report of diabetic myonecrosis observed in an adolescent patient with type 2 diabetes. A 16-year-old girl presented with acute-onset, bilateral lower extremity pain and tenderness concerning for bilateral gastrocnemius myonecrosis in the setting of poorly controlled type 2 diabetes for at least 4–5 years. Investigations revealed elevated creatine kinase levels and MRI suggestive of myonecrosis. A left gastrocnemius muscle biopsy had histological findings consistent with active myofibre necrosis and multifocal perivascular lymphocytic infiltration consistent with diabetic myonecrosis. The patient’s symptoms improved after 11 days of treatment with intravenous fluids, non-steroidal anti-inflammatory drugs, glycaemic control and physical therapy.