Contributed by Michael Torbenson, MD., John Sheaffer, MD., Robert Macauley, MD.,
John Anhalt, MD., PhD. and
William Pascule, ScD.
Published on line in February 1997
A 26 year old female had a 13 year history of poorly controlled insulin-dependent diabetes mellitus that led to renal failure and blindness. She required peritoneal dialysis which was complicated by multiple infections of the peritoneal catheter. She also was obese and hypertensive. She presented to the hospital with abdominal cellulitis, fevers, and chills. On physical examination, she had ulcerated areas of skin underneath the pannus. She underwent debridement of the wound and was diagnosed with necrotizing fascitis. Despite antibiotic treatment and wound care, the wound was not healing (Images 01) and required a second debridement several weeks later. Her peritoneal dialysate was also noted to be cloudy and cultures were obtained which were positive for Enterococcus faecalis and a wet mount preperationan also showed unusual organism (Image 02, Image 03). Because of her continued sepsis and poor prognosis, her family and team of physicians followed the patent's previously expressed wishes and proceeded with comfort measures only. The patient was transferred to a hospital nearer her home and she died several days later.