Diabetic muscle infarction in hemodialysis:a case report and literature review

Objective To investigate the clinical characteristic of diabetic muscle infarction (DMI) in hemodialysis and to improve the understanding of this disease.Methods The clinical data of one case of DMI in hemodialysis in our hospital were retrospectively analyzed, and the related literatures were reviewed to examine the clinical features, treatment, and prognosis of this condition. Results A 48-year-old man with renal failure due to diabetes who was given regular hemodialysis was admitted to our hospital. He had a sudden onset of painful swelling of his left gastrocnemius and soleus 10 days ago, with no systemic infection and trauma. Laboratory values included a significantly elevated ESR, CRP, PCT and CK etc. High signal lesion appeared on T2-weighted MRI. The double lower limb artery intima-media thickness and atherosclerotic plaque were shown on lower limb color sonography. After differential diagnosis work up, the patient was diagnosed as hemodialysis complicated with DMI. The patient was treated with intensive control of his blood glucose level and circulation improvement, anti-inflammatory and sufficient hemodialysis treatments, and his condition was improved at discharge.Conclusions DMI is a rare microangiopathic complication of diabetes, and the incidence of DMI in hemodialysis patients is lower. Physicians should have a high index of suspicion for DMI in hemodialysis patients with poorly controlled diabetic mellitus presenting with sudden onset, non-traumatic muscle pain. The early recognition and correct diagnosis of this complication, and reasonable treatments such as control of blood glucose level, analgesia, and improvement of circulation, are of great significance to improve the prognosis. In addition, we found that intensive hemodialysis treatment can effectively improve symptoms, but further clinical studies are needed to confirm.