Ecthyma in a Patient with Diabetes and a History of Bacteremia

May Leveriza-Oh, MD; Tania J. Phillips, MD, FRCPC

Disclosures

Wounds. 2004;16(11) 

In This Article

Presentation

A 51-year-old Hispanic female with poorly controlled insulin-dependent diabetes mellitus (IDDM) presented with an ulcer on the left leg. The lesion developed one month prior to presentation as a mildly pruritic erythematous papule resembling an insect bite, which gradually increased in size and ruptured to form a crusted ulcer. Over the next few days, the area around the ulcer progressively became more red, swollen, and tender and developed a purulent discharge. Two weeks prior to consult, the patient developed a fever and chills and was admitted to the hospital for one day. She was sent home on oral levofloxacin and clindamycin and was advised to clean and dress the wound daily.

The patient was diagnosed with IDDM in 1987 and has since been maintained on insulin injections and various oral hypoglycemics. Abnormally high serum glucose levels indicate poor blood sugar control (136-374mg/dL, normal=65-115mg/dL). The patient was previously hospitalized in November, 2003, at which time she presented with an ulcer on the right anterior leg associated with redness, pain, and swelling of the right lower extremity. She was afebrile and had a normal white blood cell count of 6.0. Her blood cultures, however, grew oxacillin-sensitive Staphylococcus aureus. She was started on clindamycin and levofloxacin and was discharged four days later with marked improvement.

The patient has a history of frequent development of pustules and furuncles on various areas of the body including the shins, arms, buttocks, and axillae. These would sometimes heal to form hyperpigmented scars.

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