Newly diagnosed diabetic patient presenting with crural infection

Merve Yilmaz; Arzu Gedik; Hasan Havitcioglu; Tevfik Demir; Tugba Gumus; Ulku Aybuke Tunc; Mehmet Calan; Abdurrahman Comlekci; Serkan yener; Sevinc Eraslan; Firat Bayraktar

doi:10.1530/endoabs.32.P456

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Endocrine Abstracts (2013) 32 P456 | DOI: 10.1530/endoabs.32.P456

ECE2013 Poster Presentations Diabetes (151 abstracts)

Newly diagnosed diabetic patient presenting with crural infection

Merve Yilmaz ¹ , Arzu Gedik ¹ , Hasan Havitcioglu ² , Tevfik Demir ¹ , Tugba Gümüs ¹ , Ulkü Aybüke Tunç ¹ , Mehmet Calan ¹ , Abdurrahman Cömlekci ¹ , Serkan yener ¹ , Sevinc Eraslan ¹ & Firat Bayraktar ¹

Err

Author affiliations

¹Dokuz Eylul Univerity Medical Faculty Endocrinology Department, Izmir, Turkey; ²Dokuz Eylul Univerity Medical Faculty Orthopedics Department, Izmir, Turkey.

Introduction: The incidence of diabetic foot in diabetics is 5-10%. We herein aimed to share a formerly undiagnosed diabetic patient presenting with crural infection.

Case: A 48-year-old male patient, without a formerly known disease, presented to a local medical center due to spontaneously progressing ulceration on left leg. The ulcers did not improve with antibiotics in seven days and afterwards he was referred to our hospital. At admission, his plasma glucose was found high and he was hospitalized in endocrinology department with a diagnosis of new onset diabetes and diabetic foot infection. On physical examination, two distinct ulcerations with purulent discharge and necrotic component were noted at left leg; one in the calf and the other superior to medial malleole, each with a diameter of 10 cm with a Wagner classification of 3. His laboratory findings at admission and on follow-up are given in Table. Intensive insulin treatment and antibio therapy were started. Magnetic resonance angiography revealed stenosis in the crural arteries bilaterally and antiaggregant, anticoagulant, vasodilator and statin therapy were added. His clinical signs of infection including fever persisted despite the antibiotic therapy. The ultrasonographic and MRI evaluation of the ulceration site demonstrated abscess formation beneath those ulcers. Surgical debridement and vacuum associated closure were applied respectively. Tissue grefting was applied after the local infection subsided completely. The patient was discharged after clinical stabilization was obtained.

Table 1 Admission and post treatment laboratory
	Admission	Posttreatment
CRP (mg/l)	284.8	15.8
Sedimentation (mm/h)	110	28
White bloodcell	15 000	6600
Neutrophil	13 600 (90.6%)	3500 (53.7%)
FPG (mg/dl)	415	142
Creatinine (mg/dl)	0.66	0.73
HbA1c (%)	13.1	5.2

Conclusion: Diabetic foot infection is probably the most preventable complication of diabetes, with considerable risks of morbidity and mortality. Early intervention for these ulcers and metabolic problems is critical for adequate treatment success. Therefore, one should keep in mind that diabetes may be the underlying cause or the aggrevating factor of a non healing foot ulcer and should evaluate these patients for presence of diabetes.