Diabetic Myonecrosis: An Under-Recognised Complication of Poorly Controlled Diabetes with a High Morbidity– A Clinico-Radiological Study

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Abstract Introduction: Diabetic myonecrosis is an uncommon and under-recognised complication of diabetes mellitus. We aimed to describe the clinical profile, imaging characteristics, management strategies, and outcomes of patients with diabetic myonecrosis. Methods: This retrospective study included 30 patients diagnosed with diabetic myonecrosis between 2002 and 2024. Diagnosis – based on clinical suspicion, supported by characteristic ultrasonography and magnetic resonance imaging. Demographic data, diabetes characteristics, biochemical parameters, imaging features, management approaches, recurrence, and mortality were analysed. Results: The mean age was 49.1 ± 11.7 years, with a mean diabetes duration of 12.6 ± 6.9 years and poor glycaemic control (HbA1c 8.83 ± 1.88%). Acute limb pain and swelling were the most common presentations (93.3%), predominantly involving the thigh and calf muscles. MRI revealed characteristic muscle oedema and infarction, frequently extending beyond the quadriceps to involve hamstrings, adductors, and posterior compartments. Diabetic nephropathy and retinopathy were present in 70% of patients. Most patients (83.3%) improved with conservative management. Recurrence occurred in 23.3% of cases, and the overall mortality rate was 33.3%. Recurrence was the strongest predictor of mortality (adjusted OR, 8.20; 95% CI, 1.45–46.40), while advanced kidney disease increased the risk, and higher serum albumin levels were protective. Conclusion: Diabetic myonecrosis should be considered in patients with diabetes who present with acute localised muscle pain; the presence of advanced CKD, significant proteinuria, or hypoalbuminemia identifies those at increased risk of adverse outcomes. MRI is the diagnostic modality of choice. Despite response to conservative therapy, high recurrence and mortality rates highlight the need for early recognition and long-term surveillance.

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