Case Report
A 72-year-old woman with a history of Diabetes mellitus was admitted to the hospital with loss of consciousness and Diabetic Foot Ulcer (DFU) on her right leg on June 26th, 2023 (Figure 1). According to what her family said; one month ago, she was admitted to the hospital, and right leg amputation was recommended for her but she decided not to follow the recommendation and left the hospital. She got leech therapy two days ago, and after the therapy, the wounds started bleeding and the night before admission she started losing consciousness.
On admission Blood pressure was at 135/75 mmHg, Respiratory rate was at 24 per minute, Pulse Rate was at 110 pulse/minute and the temperature was at 37.1° centigrade.
In physical examination, she was lethargic but was oriented to time and place. It was noted that crepitation in the wound has been extended to the knee.
A color Doppler ultrasonography in the evaluation of the DFU showed a monophasic arterial flow pattern, atherosclerotic plaques throughout the artery, and gas in foot muscle sheets from ankle to knee which was seen in X-Ray, too (figure 2).
Lab data on admission reported C-reactive protein at 219 mg/L, Withe blood cell count at 20000 per µL, and platelet count at 410000 per µL. The urine culture showed no growth of bacteria after 24 hours.
The patient was given Meropenem injections (1g, BD) and Linezolid injections (600g, BD) with Vitamin B6 orally (BD).
Due to the evidence, the patient was diagnosed with Necrotic fasciitis and got transfemoral amputation (figure 3).