Rat Bites in the Diabetic Foot: Clinical Clues

Abstract

BackgroundUlcers in patients with diabetic neuropathy in their feet are quite common but should be differentiated from the distinctive but rare ulceration resulting from rat bites in these insensate feet. We describe and analyze the features of rat bites in 2 patients with diabetic neuropathy in their feet and highlight 8 clinical features that should raise suspicion and alert the clinician to this possibility. MethodsWe describe and analyze the features of rat bites in 2 patients with diabetic neuropathy in their feet and highlight the distinctive clinical features of this condition. ResultsThe following features were noted: 1) blood on bed sheets on waking; 2) painless, nonsuppurating ulceration; 3) multiple ulcers that are linear, sharp, or with serrated edges; 4) varying depths within the ulcer; 5) sudden onset (was not noted the day before but found in morning); 6) ulcers not contiguous; 7) often bilateral; and 8) the sole of the foot is not involved. Early recognition and prompt treatment resulted in digit and limb salvage. ConclusionsWe describe and analyze the features of rat bites in 2 patients with diabetic neuropathy in their feet and highlight 8 clinical features that should raise suspicion and alert the clinician to this possibility.