Corpus spongiosum abscess presented as new-onset diabetes in an adult patient: a case presentation

Abstract

Rare infections, known as signal infections might be pathognomonic for patients with diabetes mellitus. A 55-year-old man without a significant medical history was admitted to our hospital with polyuria, polydipsia, dysuria, fever, chills and weight loss for the last month. A laboratory investigation showed leukocytosis and, elevated levels of C-reactive protein, sedimentation rate, blood glucose, and HbA1c. The patient was hospitalized in the internal medicine service and started intensive insulin therapy with intravenous saline infusion. The patient's fever and chills were not improved despite ceftriaxone treatment for three days. Ceftriaxone-resistant, imipenem-sensitive E. coli was grown in the blood cultures, so ceftriaxone was stopped and imipenem plus cilastatin combination was started. Detailed physical examination of the patient for fever etiology showed severe swelling in the perineal region. Superficial and scrotal ultrasonography and then pelvic magnetic resonance imaging revealed corpus spongiosum abscess. The perineal region was punctured and numerous Gram-negative bacilli and polymorphonuclear leukocytes were seen in the gram stain. Drainage catheter was inserted into the corpus spongiosum. Blood sugar levels were regulated and the patient was discharged after the antibiotic treatment was completed. As in our case, signal infections should be kept in mind especially in patients admitted with new onset of diabetes mellitus and persistent fever. A detailed physical examination should be performed in these patients and atypical areas like perineum should be carefully examined.