A Latent Autoimmune Diabetes in Adults Patient Manifesting Severe Musculoskeletal Complications
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Patients with diabetes have many different kinds of complications involving multiple or-gans, but those involving the musculoskeletal system are relatively uncommon. Diabeticmuscle infarction (DMI) is a rare, painful, and potentially serious condition in patientswith poorly controlled diabetes mellitus. A 35-year-old man diagnosed with type 2 dia-betes eight years ago, visited with severe muscle pain in the right anteromedial thighwithout any event of trauma. He had been treated with metformin, but his glycemiccontrol was very poor with a glycated hemoglobin of 14.5%. Evaluation of his painfulthigh lesion did not reveal any evidence of infection or vasculitis, but the magnetic reso-nance imaging and bone scan showed findings of DMI at vastus medialis muscle and aninsufficiency fracture at the right medial tibial condyle. He was diagnosed with retinopa-thy, neuropathy and microalbuminuria but not macrovascular complications. We alsodiagnosed his diabetes as latent autoimmune diabetes in adults (LADA) based on hislow C-peptide level, positive anti-glutamic acid decarboxylase (GAD) antibody and earlyonset diabetes. Instead of antibiotics, bed rest, analgesics and strict blood glucose con-trol with multiple daily insulin injections led to symptom improvement. This is an un-usual case of a young man with LADA experiencing severe musculoskeletal complica-tion of DMI and insufficiency fracture. If a poorly controlled diabetic patient appears tohave unaccounted soft tissue pain, musculoskeletal complications such as DMI associat-ed with hyperglycemia should be considered.
Abstract
Patients with diabetes have many different kinds of complications involving multiple or-gans, but those involving the musculoskeletal system are relatively uncommon. Diabeticmuscle infarction (DMI) is a rare, painful, and potentially serious condition in patientswith poorly controlled diabetes mellitus. A 35-year-old man diagnosed with type 2 dia-betes eight years ago, visited with severe muscle pain in the right anteromedial thighwithout any event of trauma. He had been treated with metformin, but his glycemiccontrol was very poor with a glycated hemoglobin of 14.5%. Evaluation of his painfulthigh lesion did not reveal any evidence of infection or vasculitis, but the magnetic reso-nance imaging and bone scan showed findings of DMI at vastus medialis muscle and aninsufficiency fracture at the right medial tibial condyle. He was diagnosed with retinopa-thy, neuropathy and microalbuminuria but not macrovascular complications. We alsodiagnosed his diabetes as latent autoimmune diabetes in adults (LADA) based on hislow C-peptide level, positive anti-glutamic acid decarboxylase (GAD) antibody and earlyonset diabetes. Instead of antibiotics, bed rest, analgesics and strict blood glucose con-trol with multiple daily insulin injections led to symptom improvement. This is an un-usual case of a young man with LADA experiencing severe musculoskeletal complica-tion of DMI and insufficiency fracture. If a poorly controlled diabetic patient appears tohave unaccounted soft tissue pain, musculoskeletal complications such as DMI associat-ed with hyperglycemia should be considered.
참고문헌 (20)
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