Recurrent Diabetic Ketoacidosis Triggered by Untreated Pyomyositis: A Rare Presentation in Poorly Controlled Type 2 Diabetes Mellitus

Pyomyositis is a rare bacterial infection of the skeletal muscle, traditionally associated with tropical climates. While increasingly recognized in diabetic and immunocompromised individuals, it often presents with nonspecific systemic symptoms, causing delays in diagnosis. Diabetic ketoacidosis (DKA) triggered by pyomyositis is even more uncommon and poses a diagnostic challenge. We report the case of 37-year-old woman with uncontrolled type 2 diabetes mellitus and hypertension, who presented to the hospital with recurrent DKA episodes, each associated with focal muscle pain. The first episode was linked to left gluteal pyomyositis, and the second episode, a year later, was due to a right gluteal and thigh abscess extending to the patellar tendon. Both events required intravenous antibiotics, source control with drainage, and insulin optimization. This case highlights the importance of high suspicion for occult infections such as pyomyositis in diabetic patients presenting with DKA without a clear focus and the role of early imaging and multidisciplinary management in preventing morbidity.