title: Lung abscess without sepsis in a patient with diabetes with refractory episodes of spontaneous hypoglycemia: a case report and review of the literature.
abstract: BACKGROUND
  Hypoglycemia is a cause of considerable morbidity. Although hypoglycemia has been documented in the setting of septic shock and has been associated with higher mortality, hypoglycemia in infection without sepsis has not been reported in the literature.
  
  
  METHODS
  A 72-year-old Japanese woman treated with high-dose glucocorticoids for autoimmune hemolytic anemia, as well as intensive insulin therapy for type 2 diabetes, presented with severe hypoglycemia. A lung abscess was diagnosed by imaging studies and treated with intravenous antibiotics. Hypoglycemia spontaneously recurred during lung abscess exacerbations, despite appropriate de-escalation of antidiabetic therapy. Only mild sporadic episodes of hypoglycemia occurred after the lung abscess was controlled. Infection accompanied with malnutrition and immunosuppression, although in the absence of sepsis, may have contributed to hypoglycemia.
  
  
  CONCLUSIONS
  Caution is warranted in the management of hypoglycemia in patients with diabetes with the conditions described here, that is malnutrition and immunosuppression, as infection may be a contributing factor.
authors: Gotaro
authors: G
authors: Toda
authors: Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan. midori-tky@umin.ac.jp.
authors: Midori
authors: M
authors: Fujishiro
authors: Tomohide
authors: T
authors: Yamada
authors: Nobuhiro
authors: N
authors: Shojima
authors: Hideyuki
authors: H
authors: Sakoda
authors: Ryo
authors: R
authors: Suzuki
authors: Toshimasa
authors: T
authors: Yamauchi
authors: Kohjiro
authors: K
authors: Ueki
authors: Takashi
authors: T
authors: Kadowaki