Diabetic myonecrosis, an uncommon presentation of diabetes mellitus in tropical area: A case report

Diabetic myonecrosis is an uncommon complication related to long-standing poorly controlled diabetes. A 33-year-old Sudanese male patient with type one diabetes presented with progressive, severe bilateral thigh pain with low-grade fever. Laboratory results show hyperglycemia with ketonuria and elevated creatine kinase but normal white cell blood count. The patient was diagnosed initially with diabetic ketoacidosis with pyomyositis and received analgesic and insulin; the patient partially improved. After the second evaluation, bilateral thigh MRI was requested and shows diffuse edema involving the medial muscle group of the upper third of the right side with intramuscular facial edema, appearing as low signal in T1 and high signal in T2 and fat suppression images with no evidence of collection or abscess. Diagnosis of diabetic myonecrosis was made. The patient was managed conservatively and discharge on aspirin with full recovery.