alexa Diabetic Ketoacidosis with Two Life Threatening Infecti
ISSN: 2155-6156

Journal of Diabetes & Metabolism
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Case Report

Diabetic Ketoacidosis with Two Life Threatening Infections: Mucormycosis, and Bilateral Emphysematous Pyelonepritis, Preciptating Erythema Nodosum Leprosum as the Initial Presentation of Diabetes

Ahmed Daoud1*, Amira Elbendary2,3, Mohanad Elfishawi1, Mahmoud Rabea1, Mostafa Alfishawy1,4, Sholkamy Amany MD and Wasfy Ayda MD
1Internal Medicine department – Kasr Alainy Hospital, Cairo University, Egypt
2Dermatology Department, Kasr Alainy Hospital, Cairo University, Egypt
3Ackerman Academy of Dermatopathology, New York, New York, USA
4Ichan School of Medicine, Mount Sinai/ Queens General Hospital, New York, USA
Corresponding Author : Ahmed Daoud, MD
2250 Holly Hall street
Apartment 126, Houston , Tx 77054
Tel: 8239297124
E-mail: [email protected]
Received June 19, 2014; Accepted September 16, 2014; Published September 24, 2014
Citation: Daoud A, Elbendary A, Elfishawi M, Rabea M, Alfishawy M, et al. (2014) Diabetic Ketoacidosis with Two Life Threatening Infections: Mucormycosis, and Bilateral Emphysematous Pyelonepritis, Preciptating Erythema Nodosum Leprosum as the Initial Presentation of Diabetes. J Diabetes Metab 5:433 doi:10.4172/2155-6156.1000433
Copyright: © 2014 Daoud A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Emphysematous pyelonephritis is an acute necrotizing renal and perirenal infection, caused by gas forming organism. Mucormycosis is an opportunistic aggressive fungal infection causing tissue thrombosis and necrosis. Erythema nodosum leprosum reaction is an inflammatory reaction occurring in borderline and lepromatous leprosy before, during or after multidrug treatment, where immune complexes deposit in various organs resulting in considerable damage to the organs that were site of deposition. Both emphysematous pyelonephritis and mucormycosis are infections that occur principally in diabetics, especially with poor control of blood sugar. Herein we report a 27 year old woman presenting to the emergency department with diabetic ketoacidosis as a first presentation of diabetes, where array of investigations revealed emphysematous pyelonephritis, palatal mucormycosis, and erythema nodosum leprosum. The early aggressive management with the correction of blood glucose and ketoacidosis help to give a successful outcome to the patient. To the best of our knowledge, this case is the first in English literature to report coexisting bilateral emphysematous pyelonephritis and palatal mucormycosis in a diabetic patient, precipitating erythema nodosum leprosum, and highlights the possibility of occurrence of more than one serious condition in a diabetic at a time.


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