A new therapeutic approach with tocilizumab in a 39-year-old patient with recurrent diabetic myonecrosis
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A new therapeutic approach with tocilizumab in a 39-year-old patient with recurrent diabetic myonecrosis. / Wagemann, Judith; Keller, Sarah; Noriega, Maria de Las Mercedes; Stenzel, Werner; Schneider, Udo; Krusche, Martin.
In: MOD RHEUMATOL CASE, Vol. 6, No. 1, 07.01.2022, p. 59-63.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - A new therapeutic approach with tocilizumab in a 39-year-old patient with recurrent diabetic myonecrosis
AU - Wagemann, Judith
AU - Keller, Sarah
AU - Noriega, Maria de Las Mercedes
AU - Stenzel, Werner
AU - Schneider, Udo
AU - Krusche, Martin
N1 - © Japan College of Rheumatology 2021. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
PY - 2022/1/7
Y1 - 2022/1/7
N2 - We report the case of a 39-year-old female patient with acute painful swelling of the left thigh and symmetric muscle weakness in both upper legs. The patient had a history of long-standing, poorly controlled type 1 diabetes which required dialysis. Serum inflammatory markers were highly elevated. Magnetic resonance imaging (MRI) indicated necrotic or inflammatory colliquation. As antibiotic therapy did not lead to clinical improvement, a successful anti-inflammatory therapy with prednisolone was initiated. Three months later, the patient presented with a new onset of progressive and painful muscle swelling of the right thigh. MRI showed pronounced swelling of the right adductor muscles and inflammatory markers were massively elevated. In the absence of autoantibodies or any infectious agents and the recurrent symptomatology, relapsing diabetogenic myonecrosis was diagnosed. Initially, clinical improvement could only be achieved with high-dose glucocorticosteroids. Intravenous immunoglobulins did not show an effect, whereas serological and clinical remission was achieved after we administered tocilizumab intravenously. Diabetic myonecrosis is a rare complication of long-term, poorly controlled diabetes mellitus. Acute muscle pain and elevated inflammatory markers should prompt suspicion. Contralateral muscle involvement is also suggestive of the disease. The optimisation of diabetes treatment is crucial in order to prevent further disease complications.
AB - We report the case of a 39-year-old female patient with acute painful swelling of the left thigh and symmetric muscle weakness in both upper legs. The patient had a history of long-standing, poorly controlled type 1 diabetes which required dialysis. Serum inflammatory markers were highly elevated. Magnetic resonance imaging (MRI) indicated necrotic or inflammatory colliquation. As antibiotic therapy did not lead to clinical improvement, a successful anti-inflammatory therapy with prednisolone was initiated. Three months later, the patient presented with a new onset of progressive and painful muscle swelling of the right thigh. MRI showed pronounced swelling of the right adductor muscles and inflammatory markers were massively elevated. In the absence of autoantibodies or any infectious agents and the recurrent symptomatology, relapsing diabetogenic myonecrosis was diagnosed. Initially, clinical improvement could only be achieved with high-dose glucocorticosteroids. Intravenous immunoglobulins did not show an effect, whereas serological and clinical remission was achieved after we administered tocilizumab intravenously. Diabetic myonecrosis is a rare complication of long-term, poorly controlled diabetes mellitus. Acute muscle pain and elevated inflammatory markers should prompt suspicion. Contralateral muscle involvement is also suggestive of the disease. The optimisation of diabetes treatment is crucial in order to prevent further disease complications.
KW - Adult
KW - Antibodies, Monoclonal, Humanized/therapeutic use
KW - Diabetes Mellitus
KW - Female
KW - Humans
KW - Leg
KW - Muscular Diseases
U2 - 10.1093/mrcr/rxab016
DO - 10.1093/mrcr/rxab016
M3 - SCORING: Journal article
C2 - 34505150
VL - 6
SP - 59
EP - 63
JO - MOD RHEUMATOL CASE
JF - MOD RHEUMATOL CASE
SN - 2472-5625
IS - 1
ER -