糖尿病合并下肢肌梗死一例报道并文献复习

One case of diabetic patient with lower limb muscle infarction:Case report and literatures review

报道1例70岁糖尿病患者,因"右小腿肿痛4d"入院,初步诊断为急性蜂窝织炎。予胰岛素控制血糖及抗感染治疗无效,彩超及磁共振成像提示肌梗死,予非甾体消炎药、抗凝、抗血小板等治疗1周,左胸壁出现胸大肌深部血肿,停用抗凝、抗血小板等药物,仅予非甾体消炎药及理疗有效。糖尿病肌梗死临床少见,表现不典型,容易造成误诊或漏诊,提高对其认识和警惕尤为重要。对合并严重并发症患者,抗凝、抗血小板治疗需谨慎。

A 70-year old man with diabetes mellitus complained of sudden-onset right calf pain/swelling for four days.The initial diagnosis was acute cellulitis.Hypoglycemic treatment with insulin and anti-infection therapy were ineffective.Then,diabetic muscle infarction in right calf was demonstrated by the ultrasound and further magnetic resonance imaging. After treatment with non-steroid antiinflammatory drug,odynolysis,anticoagulation and anti-platelet for nearly a week,initial muscular symptoms were alleviated significantly.However,due to a spontaneous hematoma occurred in deep pectoralis major,anticoagulant and anti-platelet drugs had to be discontinued. Non-steroid antiinflammatory drug and physiotherapy were proved to be effective.The rarity and non-specific clinical presentation of diabetic muscle infarction often lead to a delayed diagnosis or misdiagnosis.Increasing the awareness of diabetic muscle infarction and clinical suspicion is very important.In addition,it was suggested that anticoagulatie and antiplatelet therapy should be cautious enough in diabetic patients with diabetic muscle infarction and severe multiple complications.