title: A ''not so superficial" skin infection in a patient with diabetes.
abstract: A woman in her 60s with type 2 diabetes presented with a 4-week history of a rash on her chest wall, flu-like symptoms and a red right eye. On examination, there was a cellulitic rash over the right chest wall, breast and neck and a hypopyon in the right eye. Chest x-ray demonstrated right upper lobe opacification, with subsequent CT and MRI revealing bilateral collections at the lung apices, and a possible permeative bone destruction of the manubrium, respectively. A diagnosis of primary sternal osteomyelitis with associated lung abscesses, chest wall cellulitis and hypopyon due to endogenous endophthalmitis was made, with microbiological assessment identifying group B β-haemolytic streptococci. The patient underwent surgical debridement of the affected tissue and received 6&emsp14;weeks of intravenous antibiotics. This case highlights the role of multidisciplinary team involvement in management of infections and the need to consider deep-seated infection in diabetics.
authors.affiliation: Respiratory Department, University Hospitals Birmingham NHS Trust, Birmingham, UK. james.carr@nhs.net
authors.forename: James Michael
authors.initials: JM
authors.lastname: Carr
authors.forename: Guy
authors.initials: G
authors.lastname: Hagan
authors.forename: Peter
authors.initials: P
authors.lastname: Guest
authors.forename: Simon
authors.initials: S
authors.lastname: Gompertz
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002481:Cellulitis / Q000382:microbiology* / Q000628:therapy; D003646:Debridement; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003937:Diagnosis, Differential; D015818:Eye Infections, Bacterial / Q000382:microbiology*; D005260:Female; D006801:Humans; D008169:Lung Abscess / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D008875:Middle Aged; D018461:Soft Tissue Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D013290:Streptococcal Infections / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D013292:Streptococcus agalactiae
chemical_list: D000900:Anti-Bacterial Agents