A Case of Disseminated Sepsis Caused by an Unusual Microorganism in a Patient With Diabetes.

Abstract

Patients with suboptimally controlled diabetes are susceptible to a higher frequency and severity of infections from common microorganisms (1). They are also at a higher risk of acquiring sepsis at unusual sites and from uncommon microbes (2). We report a patient with a background of longstanding type 2 diabetes, multiple comorbidities, and an intra-cardiac device, who had life-threatening disseminated sepsis caused by an unusual bacterium. A 54-year-old Caucasian man with a BMI of 39.7 kg/m2, height of 177 cm (69.6 inches), weight of 124.4 kg (274.2 lb), and suboptimally controlled type 2 diabetes of >10 years’ duration presented with 3–4 weeks’ duration of a skin rash over his trunk and upper limbs that was mildly pruritic and painful to touch. During the next 2–3 weeks, the lesions over his trunk became more extensive and spread to his lower limbs, with evolution in some areas to 2-cm violaceous, painful, tender lumps and blisters with scant discharge. For the past 4 years, the patient had been taking insulin glargine and glulisine. A recent A1C was 9.4%, and he had diabetic retinopathy and peripheral neuropathy. His medical history included chronic atrial fibrillation, ischemic heart disease, and severe left ventricular systolic dysfunction, which required insertion of a cardiac resynchronization therapy defibrillator 3 years ago. He also had stage 3 chronic kidney disease and a history of previous cerebrovascular accident with good neurological recovery. Physical examination revealed multiple itchy and mildly warm lesions over his trunk and all four extremities. The rash was at different stages of evolution and included maculopapular, vesicular, and nodular lesions. In some areas, it was eczematous with asteototic changes, whereas in other areas, he had erythematous plaques with overlying necrotic crust and superficial ulceration. There was no lymphadenopathy, ulceration, abscess formation, or caseous necrosis (Figures 1 and 2 …