case_images: PMC5926487_01
case_images: Upper back demonstrating thickened skin after incision and drainage.
case_images: CRIE2018-9513768.001.jpg
case_images: PMC5926487_01_CRIE2018-9513768.001.jpg
case_images: fig1
case_images: His physical examination was significant for an extensive area of induration in the right upper back extending into the back of the neck, measured about 25 cm x 20 cm in size, and had a 3 cm x 4 cm x 3 cm area of fluctuation with erythema and tenderness (Figure 1). His laboratory investigations were significant for leukocytosis with a white blood cell count of 26,000/muL, lactic acidosis with a serum lactic acid of 2.4 mmol/L (normal 0.5-1.9 mmol/L) and serum bicarbonate of 16 mmol/L (normal 22-32 mmol/L), and poorly controlled diabetes with serum glucose of 291 mg/dL (normal 74-118 mg/dL) and subsequent hemoglobin A1C of 10.3% (normal 4.8%-5.6%).
case_images: CT scan of the chest showing a large area of subcutaneous tissue density of right upper back.
case_images: CRIE2018-9513768.002.jpg
case_images: PMC5926487_01_CRIE2018-9513768.002.jpg
case_images: fig2
case_images: Chest imaging showed bullous changes in the upper lobes of the lung, a large area of soft tissue density in the subcutaneous tissue of right upper back, and enlarged right trapezius muscle (Figure 2).
case_images: Histopathology from skin biopsy of the upper back showing fibroadipose tissue and skeletal muscle with focal acute and chronic inflammation.
case_images: CRIE2018-9513768.003.jpg
case_images: PMC5926487_01_CRIE2018-9513768.003.jpg
case_images: fig3
case_images: A skin biopsy taken from the back was sent for histopathology and showed fibroadipose tissue and skeletal muscle with focal acute and chronic inflammation with granulation tissue (Figure 3).