SAT-572 A Case Of Bilateral Diabetic Muscle Infarction In The Arm And Leg: An Unusual Presentation

Abstract Disclosure: A. Pham: None. A. Herrera Chancay: None. I. Lingvay: Novo Nordisk, Sanofi, Boehringer Ingelheim, Dexcom, Abbvie, Altimmune, Alveus Therapeutics, Amgen Inc, Antag Therapeutics, AstraZeneca, Bayer, Inc., Betagenon AB, Bioio Inc., Biomea, Carmot, Cytoki Pharma, Eli Lilly & Company, Intercept, Janssen Research & Development Company, Johnson &Johnson, Juvena, Keros Therapeutic, Inc., Mediflix, Merck, Metsera, Neurocrine, Pharmaventures, Pfizer, Inc., Regeneron Pharmaceuticals, Roche Pharmaceuticals, Shionogi, Source Bio, Structure Therapeutics, Target RWE, Terns Pharma, The Comm Group, Web MD, Zealand Pharma. Background: Diabetic muscle infarction (DMI) is a rare microvascular complication of type 1 and type 2 diabetes that leads to spontaneous necrosis of skeletal muscle. It is associated with uncontrolled, long-term diabetes and is most common in people with retinopathy, nephropathy, and neuropathy. It has unclear triggers but may be associated with ischemia-reperfusion injury, vasculitis, or hypercoagulable states. The most typical presentation is unilateral pain and swelling of the anterior thigh. Clinical Case: A 39-year-old female with type 1 diabetes complicated by retinopathy, nephropathy, and neuropathy presented with severe pain and swelling in her right arm and left leg. She had a recent admission for diabetic ketoacidosis, during which an IV infiltrated in her right forearm, with swelling and pain in that area that started a week after. She was discharged with antibiotics for presumed cellulitis but returned days later due to worsening right forearm pain and new left leg pain and weakness. Physical exam revealed non-pitting edema in the anterior compartment of her right forearm, tenderness that worsened with flexion, but no erythema or warmth. Edema was minimal in her left leg, with tenderness in her hip and groin. Labs revealed no leukocytosis, HgbA1c of 8.4% (normal 4-5.6%), CK of 461 units/L (normal 26-192 units/L) and CRP of 4.2 mg/dL (normal <0.5 mg/dL). MRI of the right forearm, now 3 weeks after the IV infiltration, showed extensive muscle edema concerning for myonecrosis. MRI of the left thigh showed extensive edema of the anterior compartment muscles. Infection, DVT, compartment syndrome and immune mediated myositis were ruled out. Based on her imaging, she was diagnosed with DMI and treated with daily baby aspirin, strict glycemic control, and holding physical therapy to allow for bed rest. After 2 weeks, her pain and swelling improved and she was discharged. Pain in both extremities resolved a week later (31 and 23 days after onset of right arm pain and left leg pain respectively). Conclusion: Cases of DMI have been described before, but upper extremity involvement is much rarer, as is involvement of multiple muscle groups, especially in bilateral extremities. It is possible that the IV infiltration caused microvascular injury that precipitated the DMI in her forearm, in addition to the typical involvement of the thigh. Trauma has not been previously reported as a precipitating factor for DMI but is plausible in this case with a unique presentation. DMI management includes ruling out other diagnoses such as thrombophlebitis, infection and compartment syndrome. MRI, while non-specific, can support the diagnosis. Treatment with aspirin, strict glycemic control, and avoiding physical therapy could shorten the duration of symptoms, with one review finding a mean recovery time of 76.5 days in people treated with physical therapy compared to 28.5 days in people receiving aspirin. Presentation: Saturday, July 12, 2025