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Case Reports in Nephrology
Volume 2013, Article ID 931523, 6 pages
http://dx.doi.org/10.1155/2013/931523
Case Report

Diabetic Muscle Infarction: A Rare Cause of Acute Limb Pain in Dialysis Patients

1Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
2Laboratory of Nephrology, Department of Microbiology and Imunology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
3Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
4Respiratory Division, University of Leuven and Department of Clinical Respiratory Medicine, Catholic University of Leuven, Herestraat 49, 3000 Leuven, Belgium

Received 18 March 2013; Accepted 7 April 2013

Academic Editors: J. Almirall, P. S. Passadakis, and H. Schiffl

Copyright © 2013 G. De Vlieger et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Diabetic muscle infarction is a rare microangiopathic complication occurring in patients with advanced diabetes mellitus. Diabetic patients with chronic kidney disease stage Vd are prone to develop this complication. The presenting symptom is a localized painful swelling of the affected limb. Symptoms usually resolve spontaneously during the following weeks, but frequent relapse can occur and in some cases swelling may lead to compartment syndrome. Biochemical blood analyses show an elevated C-reactive protein, but creatine kinase is often normal. Diagnosis can be made on clinical presentation and imaging, with magnetic resonance imaging as the gold standard. Histology is often not contributive. Treatment consists of rest, analgesics, rigorous glycemic control and low-dose aspirin. Severe cases of compartment syndrome require fasciotomy. In the current paper, we present two diabetic patients with cystic fibrosis, who are treated with automated peritoneal dialysis and suffered from episodic lower limb infarction. We subsequently review 48 episodes of diabetic muscle infarction previously reported in the literature in patients with end-stage renal disease.