Sudden onset thigh pain following admission with septic shoulder bursitis.

39 male

Sudden onset thigh pain week following hospital admission with septic subacromial/subcoracoid bursitis ( now treated)

However at this visit white cell count , CRP  not markedly elevated .

Although not volunteered on requisition form , further enquiry established patient has very poorly controlled/managed Type 2 diabetes mellitus

Diagnosis and discussion follows images

DIAGNOSIS : DIABETIC MYONECROSIS

Occurs in poorly controlled diabetes

Commonly thigh muscles

Sudden onset pain .Lab markers ( CRP, WBC )  typically only mildly deranged

Usually self limiting

Another teaching point is that in my experience, diabetes is often not volunteered on requisition forms for MSK studies but may be very relevant

Link to recent clinical review follows

Diabetic muscle infarction: a systematic review