Clinical Case Discussion

User avatar
nawrany
Contributor
Contributor
Posts: 50
Joined: 18 Oct 2010, 20:03
University & College: FASHIR UNIVERSITY FACULTY OF MEDICINE
Country & City: sudan khartoum
Graduation Year: 2004
Post-Graduation: sudanese board
MD 1ST PART MEDICINE
Job Title (other): REGISTRAR
Work Place: SAUDIA ARABEA
Has thanked: 4 times
Been thanked: 6 times
Contact:

Clinical Case Discussion

Unread post by nawrany »

A 42-year-old male immigrant from South America with poorly controlled DM type 2 (HbA1c 13%) and hypertension presented with a one-month history of progressively worsening pain in his left thigh and calf associated with secondary inability to walk. There was no history of trauma or intramuscular injections.

Medications

Insulin 70/30 bid, lisinopril 20 mg daily, ASA 81 mg daily and simvastatin 40 mg daily.

Physical examination
Image

Afebrile, and there was no evidence of arthritis or effusion. There was swelling and tenderness in the left distal quadriceps area and calf with limited range of motion of the knee. Peripheral pulses and sensation were normal.

What is the most likely diagnosis?
What tests would you order?
What treatment would you start for this patient?
These users thanked the author nawrany for the post (total 3):
ismailalaminmoneim.elomeirihussam abdalgany
Image
Noor Ebrahim
Going Well
Going Well
Posts: 14
Joined: 07 Dec 2011, 18:55
University & College: OIU, MBBS
Country & City: Omdurman
Graduation Year: 2010
Post-Graduation: plan for MRCP
Job Title (other): SHO
Work Place: not yet
Has thanked: 0
Been thanked: 3 times
Contact:

Re: Clinical Case Discussion

Unread post by Noor Ebrahim »

Alslam 3lykm
It is difficult to me to some extent but I will try to discuss it,, important information of this condition , 42 yrs old male ,from south Africa , poorly controlled diabetes and hypertension, chronic and progressive painful unilateral leg swelling.O/E afebrile ,tenderness,limitation of movement=inflammation.intact peripheral pulses.
first starting with the common causes :
DVT: but i think it is unlikely due to its long duration and no history of immobilization for long time .
Cellulitis or osteomylitis : no trauma or other risk factors.
his medications:simvastatin rarely can cause rhabdomyolysis,..
with his poorly controlled diabetes although it's rare diabetic myopathy should be put on mind.
investigation.
CBC, RFT for infection and general condition of the pt.
doppler U/S for DVT
CK for suspicion of rhabdomyolysis
then if we didn't reach the dignosis we can proceed for MRI for diabetic myopathy
Tretment according to the diagnosis and mean while conservative management ,like leg elevation and analgesia.
These users thanked the author Noor Ebrahim for the post (total 2):
ismailalaminhussam abdalgany
User avatar
Hani
Honorary Member
Honorary Member
Posts: 174
Joined: 10 Dec 2012, 00:23
Has thanked: 3 times
Been thanked: 30 times
Contact:

Re: Clinical Case Discussion

Unread post by Hani »

I agree with Dr.Noor

We also need to exclude necrotizing fasciitis, infections like myositis and tick or insects bites (South American) -

we may also go far to add the rare DM complication: diabetes myonecrosis considering his poorly controlled sugar and the inability to walk without obvious joint problem (that points to a muscular issue)

Thanks Dr.Nawrany for the nice case .. waiting for the answer or more hints
These users thanked the author Hani for the post:
hussam abdalgany
PLEASE DO NOT CONTACT ME FOR SUPPORT OR REPORTING PROBLEMS
YOU CAN CONTACT THE SITE ADMIN ACCOUNT (SudaMediCa)
TO CONTACT ME FOR PERSONAL ISSUES, PLEASE USE THE E-MAIL FEATURE
User avatar
mohamed kambal
Sketchy
Sketchy
Posts: 2
Joined: 07 Jan 2012, 17:57
University & College: U of K, MBBS
Country & City: Khartoum
Graduation Year: 2011
Post-Graduation: NIL
Job Title (other): House Officer
Work Place: Omdurman military hospital
Has thanked: 0
Been thanked: 0
Contact:

Re: Clinical Case Discussion

Unread post by mohamed kambal »

Dear doctors : Alslam 3lykm
1\ most likely diagnosis: DM Amyotrophy... Although rare but in this case with a male having uncontrolled DM and asymmetrical pain and weakness of the lower limbs i find it more reasonable. o allah a3lm..
2\ investigations: NCS and EMG
3\RX: bed rest and physiotherapy and control of dm..with pain killer for the pain.

with my best rgards
User avatar
Hani
Honorary Member
Honorary Member
Posts: 174
Joined: 10 Dec 2012, 00:23
Has thanked: 3 times
Been thanked: 30 times
Contact:

Re: Clinical Case Discussion

Unread post by Hani »

Dear Dr.Kambal,

DM Amyotrophy is a neuropathy, we usually see muscular atrophy we depressed or absent reflexes of knee and ankle. in this case there is swelling of muscles and nothing was mentioned about neuro signs
PLEASE DO NOT CONTACT ME FOR SUPPORT OR REPORTING PROBLEMS
YOU CAN CONTACT THE SITE ADMIN ACCOUNT (SudaMediCa)
TO CONTACT ME FOR PERSONAL ISSUES, PLEASE USE THE E-MAIL FEATURE
einas
Contributor
Contributor
Posts: 117
Joined: 09 Jan 2012, 01:51
University: Omdurman Ahlia University
Degree (College): MBBS
Graduation Year: 2005
Plan \ Working On: MRCP
Speciality: General Medicine
Job Title: SHO (Medical or Resident)
Work Place: Burjeel hospital-Abudhabi-UAE
Has thanked: 17 times
Been thanked: 21 times
Contact:

Re: Clinical Case Discussion

Unread post by einas »

another DD is diabetic myonecrosis which is affect the long standing diabetics the most common site is the lower limbs and esp the quadriceps causing the tenderness swelling and restriction of joint movement as in this case with the knee joint .

thank u for the interesting case
hussam abdalgany
Few Steps
Few Steps
Posts: 6
Joined: 16 Mar 2013, 17:23
University: Science and Technology - Omdurman
Degree (College): MBBS
Graduation Year: 2012
Plan \ Working On: MRCP
Speciality: Emergency Medicine
Job Title: House Officer (intern)
Work Place: Bahri teaching hospital / khartoum bahri / sudan
Has thanked: 8 times
Been thanked: 1 time
Contact:

Re: Clinical Case Discussion

Unread post by hussam abdalgany »

Alsalam alikom ,, thanx doctor alnawrany for the nice case ,, there is alot of logic DD mentioned by the nice doctors above and I agree with them waiting for your final judjment .
Post Reply

Return to “Quizes & Questions”