An unusual cause of diabetic ketoacidosis and fulminant septicaemia.
BACKGROUND
Diabetic ketoacidosis (DKA) is a common medical emergency. Resistant and recurrent DKA can be due to underlying infection, and a detailed travel history may be important in determining the cause in such cases. We report here a case of unusual DKA and fulminant septicaemia in a Caucasian male with Type 1 diabetes 2 years after returning from living in Thailand.


METHODS
A 39-year-old Caucasian male was diagnosed with Type 1 diabetes whilst working in Thailand where he also subsequently developed a cavitating lung lesion diagnosed locally as pulmonary tuberculosis. Two years after returning to the UK he was admitted with DKA and septicaemia. Despite correction of his DKA his condition deteriorated and he developed a fluid collection anterior to the left hip on computed tomography scanning. Blood and fluid aspirate cultures confirmed a diagnosis of melioidosis, a rare fulminant septicaemia in the UK, but endemic in South-east Asia and tropical Australia. Full recovery followed changing antibiotics to intravenous ceftazidime with no relapse 3 years after acute episode.


CONCLUSIONS
Physicians as well as microbiologists should consider melioidosis in anyone presenting with septicaemia and/or resistant DKA, especially if the history includes travel to endemic areas or if the cultures suggest Pseudomonas-like organism. With increasing international travel, it is crucial to remember that good travel history could be life-saving in some cases of septicaemia.
Hassanein
M M
MM
Diabetes & Endocrinology Department, Royal Liverpool and Broadgreen University Hospitals, UK. mhassanein@aol.com
Croall
J
J
Ewins
D L
DL
Worth
R C
RC
D000328:Adult; D016470:Bacteremia / Q000150:complications* / Q000188:drug therapy; D002442:Ceftazidime / Q000627:therapeutic use; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000473:pathology; D016883:Diabetic Ketoacidosis / Q000209:etiology*; D004318:Doxycycline / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008554:Melioidosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D012307:Risk Factors; D013785:Thailand; D014195:Travel; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D002442:Ceftazidime; D004318:Doxycycline