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Case Reports in Nephrology
Volume 2017, Article ID 7240156, 3 pages
Case Report

Diabetic Muscle Infarction Masquerading as Necrotizing Fasciitis

1Department of Nephrology, Maimonides Medical Center, Brooklyn, NY, USA
2Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA
3Technion American Medical Program, Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
4Department of Infectious Disease, Maimonides Medical Center, Brooklyn, NY, USA

Correspondence should be addressed to Ankur Sinha; gro.demsedinomiam@ahnisna

Received 19 February 2017; Accepted 11 April 2017; Published 26 April 2017

Academic Editor: Rumeyza Kazancioglu

Copyright © 2017 Kalyana C. Janga 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.


A 43-year-old male patient with past medical history of diabetes mellitus (DM), end stage renal disease (ESRD) on hemodialysis (HD), congestive heart failure (CHF), obstructive sleep apnea (OSA), and chronic anemia presented with complaints of left thigh pain. A computerized tomogram (CT) of the thigh revealed evidence of edema with no evidence of a focal collection or gas formation noted. The patient’s clinical symptoms persisted and he underwent magnetic resonance imaging (MRI) of his thigh which was reported to show small areas of muscle necrosis with fluid collection. These findings in the acute setting concerned necrotizing fasciitis. After careful discussion following a multidisciplinary approach, a decision was made to perform a fasciotomy with tissue debridement. The patient was treated with IV antibiotics and discharged with a vacuum assisted wound drain. The surgical pathology revealed evidence of muscle edema with necrosis. Seven weeks later the patient presented with similar complaints on the other thigh (right thigh). MRI of the thighs revealed worsening edema with features suggestive of myositis and possible muscle infarction. A CT guided biopsy of the right quadriceps muscle revealed fibrotic interstitial connective tissue and no evidence of necrosis. This favored a diagnosis of diabetic muscle infarction. The disease was managed with pain control, strict diabetes management, and aggressive dialysis.