Diabetic muscle infarction with high fever

A 56-year-old man showed almost simultaneous onset of high fever and right non-traumatic thigh pain and swelling. His body temperature rose to 39.3°C and he was unable to walk due to the pain. His history of type 2 diabetes exceeded 10 years and he had diabetic retinopathy and dialysis-requiring nephropathy. He was initially regarded as having pyomyositis and was administered antibiotics. His symptoms did not however, subside and were thus managed with paracetamol, which had limited efficacy. C-reactive protein (CRP) and creatine kinase (CK) were elevated, peaking at 19.3 mg/L (normal range: 0-0.14) and 1250 IU/L (normal range: 59-248), respectively.