An unusual cause of multiple foot ulcers in a patient with type 2 diabetes

Abstract

Diabetes is the most common cause of nontraumatic lower limb amputation. The majority of those amputations are preceded by an ulcer, usually as a result of peripheral neuropathy, peripheral vascular disease, or a combination of both. Regular foot examination and multi-disciplinary team approach are supported by evidence as tools to reduce foot ulceration. A cause for foot ulceration is not always evident, but presumed trauma or burn are usually thought. We are presenting a rather unusual case of a 70-year-old patient with long-standing diabetes and peripheral sensory neuropathy who first presented with bilateral superficial foot ulcers. On follow-up visits, further new superficial multiple ulcers were discovered and a possibility of rat bite was raised which he and his family denied. His daughter later confirmed the sighting of rodent biting his flesh. Rodent bites causing foot ulcers are rare; however, the clinician's vigilance is key for the early detection and treatment.