Thomas Seth
University of New Mexico, Albuquerque, NM, United States of America.
Am J Emerg Med. 2025 Aug 24. doi: 10.1016/j.ajem.2025.08.055.
Diabetes mellitus (DM) is one of the most prominent comorbidities in the United States and other developed nations, affecting approximately 21 million Americans (Selvin et al., 2014 [1]). A significant portion of diabetic individuals struggle with glycemic control, leading to numerous associated medical complications. Emergency physicians (EPs) are well acquainted with many, but not all, of the acute and chronic complications of uncontrolled diabetes. Diabetic myonecrosis is a rare and likely underdiagnosed complication of uncontrolled diabetes that has been underreported in the emergency medicine (EM) literature.
A 41-year-old insulin-dependent diabetic male presented to the emergency department with a month of worsening left lower extremity pain, swelling and paresthesia's. He had undergone a negative workup for a deep vein thrombosis at an outside hospital and did not report any preceding trauma. He denied any systemic infectious symptoms and had stable vital signs. His exam was notable for isolated swelling of his left posterior leg without erythema or fluctuance. His laboratory analysis was notable for elevated inflammatory markers and glucose. A contrasted CT study was performed which was suggestive of diabetic myonecrosis, later confirmed by MRI. The pt. was admitted for glucose and pain control and discharged home four days later.
Diabetic myonecrosis is a rare and likely underdiagnosed complication of uncontrolled diabetes that has been underreported in the emergency medicine (EM) literature. Emergency physicians will be better able to recognize and correctly diagnose diabetic myonecrosis by having a higher index of suspicion for it and being more familiar with its typical presentation.
糖尿病（DM）是美国和其他发达国家最突出的合并症之一，影响着约2100万美国人（塞尔文等人，2014年[1]）。很大一部分糖尿病患者在血糖控制方面存在困难，导致许多相关的医疗并发症。急诊医生（EPs）对未控制的糖尿病的许多急性和慢性并发症有所了解，但并非全部。糖尿病性肌坏死是一种罕见且可能未被充分诊断的未控制糖尿病并发症，在急诊医学（EM）文献中报道较少。
一名41岁的胰岛素依赖型糖尿病男性因左下肢疼痛、肿胀和感觉异常加重一个月就诊于急诊科。他在外院进行了深静脉血栓形成的检查，结果为阴性，且未报告任何先前的创伤史。他否认有任何全身感染症状，生命体征稳定。体格检查发现其左小腿后部孤立性肿胀，无红斑或波动感。实验室分析显示炎症标志物和血糖升高。进行了增强CT检查，提示为糖尿病性肌坏死，后来MRI证实。患者因血糖控制和疼痛控制入院，四天后出院。
糖尿病性肌坏死是一种罕见且可能未被充分诊断的未控制糖尿病并发症，在急诊医学（EM）文献中报道较少。急诊医生通过提高对其的怀疑指数并更熟悉其典型表现，将能够更好地识别和正确诊断糖尿病性肌坏死。
