A diabetic woman with a swollen forearm
A 58 year-old-woman with a three-week history of left upper forearm pain was admitted to our hospital. She noted a history of type II DM, which was diagnosed five months ago. She did not have any history of retinopathy, nephropathy, or neuropathy. Her current condition began with a sudden onset of swelling and pain in the left forearm, extending to her fingers. Before this recent admission, several antibiotics and non-steroidal anti-inflammatory drugs were prescribed for her, with no improvement. On physical examination, she was afebrile with severe swelling and tenderness in her forearm. Ophthalmological examination was normal and no evidence of retinopathy or nephropathy was found. The white blood cell count was 17500 (normal, 4800–10800) with 80% neutrophils (normal, 33–75%). Fasting blood glucose was 235 mg/dl (normal, 70–105) and hemoglobin A1C was 6.5% (normal, < 6%). Other laboratory results were as follows: Erythrocyte sedimentation rate (ESR) 17 mm/hour (normal, 0–25), creatine kinase (CK) 5930 U/L (normal, 25–175), lactate dehydrogenase (LDH) 780 U/L (normal, 0–480), aspartate transaminase 89 U/L (normal, < 31), and alanine transaminase 53 U/L (normal, < 31). Blood cultures were negative. Arterial and venous Doppler ultrasound of the left forearm was normal.\nMagnetic resonance imaging (MRI) showed diffuse edema and abnormal low and high signal intensities in the soft tissues of the left forearm []. A diagnosis of DMI was made. The blood glucose was controlled by oral hypoglycemic agents. Her muscle enzymes were gradually decreased to 143 and 504 for creatine kinase (CK) and Lactate dehydrogenase (LDH), respectively. She was discharged without any swelling or pain eight days later. On a follow-up visit after two months, she did not have any complaint in her forearm. After three months, post-treatment MRI was performed that showed no abnormal signal intensity in the soft tissues, or bony structures [].