Progressive painful syndromes due to skeletal muscle injuries rather than diabetic neuropathy are unusual complications of diabetes mellitus (DM). Two clinical cases are presented: Case 1 (pyomyositis: leg location) and Case 2 (muscle infarction: thigh location). Discussion on how to proceed the diagnosis based on clinical features are included as it is critical for early and proper treatment since approaches highly differ in the two situations. These complications can mimic thrombophlebitis, rabdomyolises or a neoplasm, therefore the diagnosis of a diabetes-related disorder may be overlooked. If pyomyositis is not correctly treated with antibiotics and in some cases with surgery, systemic infection and even death may occur, whereas muscle infarction only requires rest and analgesia. Image and laboratorial investigations can be of help to differentiate these syndromes, although some findings can overlap. Thus, the present report emphasizes the importance to include these diseases when limb painful syndromes are to be investigated in a diabetic patient.
Diabetes mellitus; Pyomyositis; Skeletal muscle infarction; Pain; Infection
