Diabetic myonecrosis is a rare complication of diabetes. Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc Diabetes mellitus type 1 (Type 1 diabetes Type I diabetes T1D T1DM IDDM juvenile diabetes is a form of Diabetes mellitus. Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non - Insulin -dependent Diabetes mellitus (NIDDM or adult-onset diabetes is a metabolic Gestational diabetes (or gestational diabetes mellitus, GDM) is a condition in which women without previously diagnosed diabetes exhibit high blood Impaired fasting glycaemia (IFG is a pre-diabetic state of dysglycemia associated with insulin resistance and increased risk of cardiovascular pathology although of lesser risk than Impaired Glucose Tolerance (IGT is a pre- Diabetic state of dysglycemia that is associated with Insulin resistance and increased risk of cardiovascular pathology Diabetes is a Chronic disease with no cure As of 2008. It is associated with an impaired Glucose cycle, altering Metabolism. The diet most often recommended for people who suffer from Diabetes mellitus is high in Dietary fiber, especially soluble fiber but low in fat (especially Saturated fat Anti-diabetic drugs treat Diabetes mellitus by lowering Glucose levels in the blood Conventional insulinotherapy is a therapeutic regimen for treatment of Diabetes mellitus which contrasts with the newer Intensive insulinotherapy. Intensive insulinotherapy is a therapeutic regimen for Diabetes mellitus treatment Cardiovascular disease or cardiovascular diseases refers to the class of diseases that involve the Heart or Blood vessels ( arteries and Diabetic coma is a Medical emergency in which a person with Diabetes mellitus is Comatose (unconscious because of one of the acute complications Diabetic hypoglycemia describes a low blood glucose level occurring in a person with Diabetes mellitus. Diabetic ketoacidosis (DKA is a life-threatening complication in patients with diabetes mellitus Nonketotic hyperosmolar coma (nonketotic Hyperglycaemia) is a type of Diabetic coma associated with a high mortality seen in Diabetes mellitus type 2. Diabetic nephropathy ( nephropatia diabetica) also known as Kimmelstiel-Wilson syndrome and intercapillary glomerulonephritis, is a progressive Kidney Diabetic neuropathies are neuropathic disorders that are associated with Diabetes mellitus. Diabetic retinopathy is Retinopathy (damage to the Retina) caused by complications of Diabetes mellitus, which can eventually lead to Blindness For women with Diabetes mellitus, Pregnancy can present some particular challenges for both mother and child Blood sugar, used in a physiological context is a misnomer and misleading Fructosamine is a compound that can be considered the result of a reaction between Fructose and Ammonia or an Amine (with a molecule of water being released A glucose tolerance test in medical practice is the administration of Glucose to determine how quickly it is cleared from the blood Glycosylated (or glycated hemoglobin ( hemoglobin A1c Hb1c, or HbA1c) is a form of Hemoglobin used primarily to identify the average Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc It is caused by infarcted muscle tissue, usually in the thigh. In Medicine, an infarction is the process resulting in a Macroscopic area of necrotic tissue in some organ caused by loss of adequate Blood supply Muscle (from Latin musculus, diminutive of mus "mouse" is contractile tissue of the body and is derived from the
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Epidemiology
The mean age at presentation is thirty-seven years with a reported range of nineteen to sixty-four years. The mean age of onset since diagnosis of diabetes is fifteen years. Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc The female:male ratio is 1. 3:1. Other diabetic complications such as nephropathy, neuropathy, retinopathy and hypertension are usually present. Nephropathy refers to damage to or disease of the Kidney. An older term for this is nephrosis. Neuropathy is a medical term usually short for Peripheral neuropathy. Retinopathy is a general term that refers to some form of non-inflammatory damage to the Retina of the Eye. Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated Its major symptom is the acute onset muscle pain, usually in the thigh, in the absence of trauma. Signs include exquisite muscle tenderness and swelling.
Investigations and diagnosis
Tissue biopsy is the gold standard. A biopsy (in Greek: βίος life and όψη look/appearance is a Medical test involving the removal of cells or tissues The gold standard is a monetary system in which a region's common media of exchange are paper notes that are normally freely convertible into pre-set fixed quantities of Gold Macroscopically this reveals pale muscle tissue. Macroscopic is commonly used to describe physical objects that are measurable and observable by the Naked eye. Microscopically infarcted patches of myocytes. Microscopic is a term used to describe objects smaller than those that can easily be seen by the naked Eye and which require a lens or Microscope to see In Medicine, an infarction is the process resulting in a Macroscopic area of necrotic tissue in some organ caused by loss of adequate Blood supply A myocyte (also known as a myocardial cell is the type of cell found in heart muscles. Necrotic muscle fibers are swollen and eosinophilic and lack striations and nuclei. Necrosis (in Greek Νεκρός = "dead" is the name given to unnatural Death of cells and living tissue. See also Eosin Eosinophilic means loves eosin, and refers to the Staining of certain tissues, cells, or Organelles Small-vessel walls are thickened and hyalinized, with luminal narrowing or complete occlusion. The term hyaline (from the Greek ὕαλος ‘glassy’ literally refers to a substance with a glass-like appearance Biopsy cultures for bacteria, fungi, acid-fast bacilli and stains are negative in simple myonecrosis. The Bacteria ( singular: bacterium) are a large group of unicellular Microorganisms Typically a few Micrometres in length bacteria have A fungus (ˈfʌŋgəs is a eukaryotic Organism that is a member of the kingdom Fungi (ˈfʌndʒaɪ Acid-fastness is a physical property of some bacteria referring to their resistance to decolorization by acids during staining procedures
Creatine kinase is found to be normal. Creatine kinase (CK also known as creatine phosphokinase (CPK or phosphocreatine kinase, is an Enzyme ( expressed by various tissue types ESR is elevated. The erythrocyte sedimentation rate (ESR also called a sedimentation rate, sed rate, or Biernacki Reaction, is the rate at which Red blood cells Planar X-ray reveals soft tissue swelling and bone scan shows non specific uptake. Bone imaging is a study to visually detect Bone abnormalities CT shows muscle oedema with preserved tissue planes (non-contrast enhancing). MRI shows increased signal on T2 weighted images within areas of muscle oedema. Arteriography reveals large and medium vessel arteriosclerosis occasionally with dye within the area of tissue infarction . Angiography or arteriography is a Medical imaging technique in which an X-ray image is taken to visualize the inside or lumen, of blood vessels Electromyography shows non specific focal changes. Electromyography (EMG is a technique for evaluating and recording the activation signal of muscles
Treatment
Treatment includes supportive care with analgesics and anti-inflammatory agents. Anti-inflammatory refers to the property of a substance or treatment that reduces Inflammation. Exercise should be limited as it increases pain and extends the area of infarction. Symptoms usually resolve in weeks to months, but fifty percent of sufferers will experience relapse in either leg. The majority diagnosed with diabetic myonecrosis die within 5 years.
Pathophysiology
The pathogenesis of this disease is unclear. Arteriosclerosis obliterans has been postulated as the cause, along with errors of the clotting and fibrinolytic pathways such as antiphospholipid syndrome. Arteriosclerosis refers to a hardening of medium and large Arteries. Coagulation is a complex process by which Blood forms Clots It is an important part of Hemostasis (the cessation of blood loss from a damaged vessel whereby Fibrinolysis is the process wherein a Fibrin clot, the product of Coagulation, is broken down Antiphospholipid syndrome (APS or APLS or antiphospholipid antibody syndrome is a disorder of Coagulation, which causes blood clots ( Thrombosis) in both [1]
Differential Diagnosis
A large number of conditions may cause symptoms and signs similar to diabetic myonecrosis and include: deep vein thrombosis, thrombophlebitis, cellulitis, fasciitis, abscess, haematoma, myositis, pseudothrombophlebitis (ruptured synovial cyst), pyomyositis, parasitic myositis, osteomyelitis, calcific myonecrosis, myositis ossificans, diabetic myotrophy, muscle strain or rupture, bursitis, vasculitis, arterial occlusion, haemangioma, lymphoedema, sarcoidosis, tuberculosis, cat-scratch disease, amyloidosis, as well as tumours of lipoma, chondroma, fibroma, leiomyoma and sarcoma. In Medicine, deep vein thrombosis (also known as deep-vein thrombosis or deep venous thrombosis and usually abbreviated as DVT) is the formation Thrombophlebitis is Phlebitis (vein Inflammation) related to a blood clot or Thrombus. Cellulitis is an Infection of the deep Subcutaneous tissue of the Skin. In medicine fasciitis /ˌfæʃiˈɑɪ̯tɪs/ refers to an inflammation of the Fascia. An abscess (abscessus is a collection of Pus (dead Neutrophils) that has accumulated in a cavity formed by the tissue on the basis of an infectious process A hematoma, or haematoma, is a collection of Blood outside the blood vessels generally the result of Hemorrhage, or more specifically Internal bleeding Myositis is a general term for Inflammation of the Muscles Many such conditions are considered likely to be caused by Autoimmune conditions rather Pyomyositis, also known as tropical pyomyositis or myositis tropicans is a Bacterial Infection of the Skeletal muscles which results Osteomyelitis is an Infection of Bone or Bone marrow, usually caused by Pyogenic Bacteria or Mycobacteria. Bursitis is the Inflammation of one or more bursae (small sacs of Synovial fluid in the body Vasculitis (plural vasculitides) a group of diseases featuring Inflammation of the wall of Blood vessels including veins ( Phlebitis) arteries A hemangioma is a Congenital Benign Tumour or Vascular malformation of endothelial cells (the cells that line blood vessels Lymphedema, also spelled lymphoedema, also known as lymphatic obstruction, is a condition of localized Fluid retention caused by a compromised Sarcoidosis, also called sarcoid (from the Greek sarx, meaning "flesh" or Besnier-Boeck disease, is an immune system disorder characterized Tuberculosis (abbreviated as TB for tubercle bacillus or T u' b' erculosis Bacillus --> is a common Cat Scratch Fever is an Album by Ted Nugent released in 1977 as well as the name of the album's title song In Medicine, amyloidosis refers to a variety of conditions in which Amyloid Proteins are abnormally deposited in organs and/or tissues A lipoma is a Benign tumor composed of fatty tissue. These are the most common form of Soft tissue tumor A Chondroma is a benign cartilaginous Tumor, which is encapsulated with a lobular growing pattern Fibromas (or fibroid tumors or fibroids) are Benign Tumors that are composed of fibrous or Connective tissue. A leiomyoma (plural is 'leiomyomata' is a Benign Smooth muscle Neoplasm that is not Premalignant. A sarcoma (from the Greek 'sarx' meaning "flesh" is a Cancer of the connective or supportive tissue ( Bone, Cartilage, Fat
References
- Wintz R, Pimstone K, Nelson S (Sep-Oct 2006). "Detection of diabetic myonecrosis. Complication is often-missed sign of underlying disease.". Postgrad Med 119 (3): 66–9. PMID 17128647. - Case report
- Mousa A, Hussein S, Daggett P & Coates P (7–9 November 2005). "Spontaneous non-traumatic muscle pain in diabetes." (abstract page). Endocrine Abstracts 10: DP12. - Poster Presentation, 196th Meeting of the Society for Endocrinology, London, UK
- Subbiah V, Raina R, Kaelber D, Chung-Park M, Halle D, Mansour D & Perzy H (2004). Diabetic Myonecrosis (Rare And Ominous Complication Of A Common Disease) (PDF). American Medical Association Research Symposium. - Poster presentation
Footnotes
- ^ Reyes-Balaguer J, Solaz-Moreno E, Morata-Aldea C, Elorza-Montesinos P (Apr 2005). "Spontaneous diabetic myonecrosis.". Diabetes Care 28 (4): 980–1. doi:. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 15793211.
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