A 47-year-old man with a history of diabetes diagnosed five years earlier, with irregular metabolic control (bilateral amaurosis and two hospitalizations in the last year due to diabetic ketoacidosis NPHclamide), and initially treated with glibenPHclamide.
She presented with a two-week history of pain and progressive volume increase secondary to a fall, associated with somnolence, anorexia and respiratory distress, without fever.
In a primary health care center, 4 million IU of sodium penicillin G was administered.
Upon admission to the emergency service, he was found to suffer from drowsiness, cold, hypotensive, and fainting.
Physical examination of the lower extremities revealed a necrotic lesion and blisters in the left pretibial area of 30 x 10 cm, absence of popliteal pulses and dorsalis pedis to the sealant.
Examinations showed leukocytosis (20,400/mm3), hyperglycemia (539 mg/dL), metabolic acidosis (pH 6,9), elevated C-reactive protein (189 mg/L) and renal dysfunction (creatinine, 5.5 mmol/dL).
Surgical removal revealed muscle necrosis of the left anterior lateral compartment. Samples were sent for culture and biopsy.
The patient was admitted to the ICU with a diagnosis of necrotizing fasciitis and severe sepsis, starting antimicrobial treatment with ceftriaxone and clindamycin, analgesia with fentanyl and metabolic correction with sodium bicarbonate, calcium gluconate.
The patient remained stable, afflicted with improvement of metabolic parameters, but with persistence and progression of the necrotic lesion in the left side.
The histopathological study reported the existence of a dense and muscular fibroconective tissue indicating an acute necrotizing inflammatory process and presence of amphotericin B-type hyphae amphotericin B, compatible.
Culture was negative for fungal elements.
After 20 days of antifungal treatment and three surgical debridements, MRI showed necrotizing infectious involvement of the tuberosity of the tibia, so it was decided to perform a suprapatellar amputation of the left tibia.
The study with intraoperative biopsy of the proximal section margin did not demonstrate the presence of mucormyc elements.
The patient received favorable treatment from the surgical and infectious point of view, completing 30 days of treatment with amphotericin B. At the time of preparing this report, he was discharged under occupational controls with physiatrist.
