Diabetic Muscle Infarction Masquerading as Necrotizing Fasciitis
A 43-year-old male patient with past medical history of diabetes mellitus (DM), end stage renal disease (ESRD) on hemodialysis (HD), congestive heart failure (CHF), obstructive sleep apnea (OSA), and chronic anemia presented with complaints of left thigh pain. A computerized tomogram (CT) of the thi...
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| Format: | Article |
| Language: | English |
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Wiley
2017-01-01
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| Series: | Case Reports in Nephrology |
| Online Access: | http://dx.doi.org/10.1155/2017/7240156 |
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| author | Kalyana C. Janga Ankur Sinha Perry Wengrofsky Phone Oo Sheldon Greenberg Regina Tarkovsky Kavita Sharma |
| author_facet | Kalyana C. Janga Ankur Sinha Perry Wengrofsky Phone Oo Sheldon Greenberg Regina Tarkovsky Kavita Sharma |
| author_sort | Kalyana C. Janga |
| collection | DOAJ |
| description | A 43-year-old male patient with past medical history of diabetes mellitus (DM), end stage renal disease (ESRD) on hemodialysis (HD), congestive heart failure (CHF), obstructive sleep apnea (OSA), and chronic anemia presented with complaints of left thigh pain. A computerized tomogram (CT) of the thigh revealed evidence of edema with no evidence of a focal collection or gas formation noted. The patient’s clinical symptoms persisted and he underwent magnetic resonance imaging (MRI) of his thigh which was reported to show small areas of muscle necrosis with fluid collection. These findings in the acute setting concerned necrotizing fasciitis. After careful discussion following a multidisciplinary approach, a decision was made to perform a fasciotomy with tissue debridement. The patient was treated with IV antibiotics and discharged with a vacuum assisted wound drain. The surgical pathology revealed evidence of muscle edema with necrosis. Seven weeks later the patient presented with similar complaints on the other thigh (right thigh). MRI of the thighs revealed worsening edema with features suggestive of myositis and possible muscle infarction. A CT guided biopsy of the right quadriceps muscle revealed fibrotic interstitial connective tissue and no evidence of necrosis. This favored a diagnosis of diabetic muscle infarction. The disease was managed with pain control, strict diabetes management, and aggressive dialysis. |
| format | Article |
| id | doaj-art-ee9a124b7f094574adfacaca368ced25 |
| institution | Kabale University |
| issn | 2090-6641 2090-665X |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Nephrology |
| spelling | doaj-art-ee9a124b7f094574adfacaca368ced252025-02-03T01:32:11ZengWileyCase Reports in Nephrology2090-66412090-665X2017-01-01201710.1155/2017/72401567240156Diabetic Muscle Infarction Masquerading as Necrotizing FasciitisKalyana C. Janga0Ankur Sinha1Perry Wengrofsky2Phone Oo3Sheldon Greenberg4Regina Tarkovsky5Kavita Sharma6Department of Nephrology, Maimonides Medical Center, Brooklyn, NY, USADepartment of Medicine, Maimonides Medical Center, Brooklyn, NY, USATechnion American Medical Program, Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelDepartment of Nephrology, Maimonides Medical Center, Brooklyn, NY, USADepartment of Nephrology, Maimonides Medical Center, Brooklyn, NY, USADepartment of Medicine, Maimonides Medical Center, Brooklyn, NY, USADepartment of Infectious Disease, Maimonides Medical Center, Brooklyn, NY, USAA 43-year-old male patient with past medical history of diabetes mellitus (DM), end stage renal disease (ESRD) on hemodialysis (HD), congestive heart failure (CHF), obstructive sleep apnea (OSA), and chronic anemia presented with complaints of left thigh pain. A computerized tomogram (CT) of the thigh revealed evidence of edema with no evidence of a focal collection or gas formation noted. The patient’s clinical symptoms persisted and he underwent magnetic resonance imaging (MRI) of his thigh which was reported to show small areas of muscle necrosis with fluid collection. These findings in the acute setting concerned necrotizing fasciitis. After careful discussion following a multidisciplinary approach, a decision was made to perform a fasciotomy with tissue debridement. The patient was treated with IV antibiotics and discharged with a vacuum assisted wound drain. The surgical pathology revealed evidence of muscle edema with necrosis. Seven weeks later the patient presented with similar complaints on the other thigh (right thigh). MRI of the thighs revealed worsening edema with features suggestive of myositis and possible muscle infarction. A CT guided biopsy of the right quadriceps muscle revealed fibrotic interstitial connective tissue and no evidence of necrosis. This favored a diagnosis of diabetic muscle infarction. The disease was managed with pain control, strict diabetes management, and aggressive dialysis.http://dx.doi.org/10.1155/2017/7240156 |
| spellingShingle | Kalyana C. Janga Ankur Sinha Perry Wengrofsky Phone Oo Sheldon Greenberg Regina Tarkovsky Kavita Sharma Diabetic Muscle Infarction Masquerading as Necrotizing Fasciitis Case Reports in Nephrology |
| title | Diabetic Muscle Infarction Masquerading as Necrotizing Fasciitis |
| title_full | Diabetic Muscle Infarction Masquerading as Necrotizing Fasciitis |
| title_fullStr | Diabetic Muscle Infarction Masquerading as Necrotizing Fasciitis |
| title_full_unstemmed | Diabetic Muscle Infarction Masquerading as Necrotizing Fasciitis |
| title_short | Diabetic Muscle Infarction Masquerading as Necrotizing Fasciitis |
| title_sort | diabetic muscle infarction masquerading as necrotizing fasciitis |
| url | http://dx.doi.org/10.1155/2017/7240156 |
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