LAUSR

Abstract Introduction. Diabetes mellitus is one the most frequent pathologies that affect the general population in the modern era, infections being one of the main reasons why the diabetic patient will present to an emergency room. The diabetic patient can develop infections with various germs and locations, that have a tendency to reoccur and have an unfavourable evolution compared to the general population. Case report. A 71 year old female patient, diabetic and with significant cardiovascular pathology is admitted with a persistent febrile syndrome after 7 days on antibiotic treatment for respiratory infection. She had recently had a neurosurgical evaluation for lumbar pain; radiology had shown a compression of the T12-L1 vertebral bodies, the neurosurgeon stating that surgery was not recommended because of the associated pathologies. Clinical examination reveals a poor general state, fever, pulmonary: bilateral basal subcrepitant rales, BP = 100/60 mmHg, AV = 100 BPM irregular. Blood work showed: leucocytosis with neutrophilia, inflammatory syndrome with high procalcitonin levels, hyperglycinaemia, nitrogen retention; chest X-ray shows stasis and the echocardiography EF 25%. The complete clinical examination detected a right inguinal abscess, that had a slow, favourable evolution after drainage and antibiotic therapy according to the antimicrobial susceptibility testing (AST) (blood culture with staph, wound culture with E.Coli). After 2 weeks, the antibiotic therapy was discontinued because of the favourable clinical and lab work evolution; after 24 hours the patient is febrile again, the leucocytosis and inflammatory syndrome reappear without any other clinical changes. The infectious assessment was redone: sterile wound cultures, sterile urine cultures, no valvular vegetation on echocardiography, a CT of the chest, abdomen and pelvic area suggestive for T12-L1 spondylodiscitis. Conclusions. The etiological diagnosis of the febrile syndrome in a diabetic patient can be extremely difficult in practice. In our case, the patient had not noticed the inguinal abscess and the lumbar pain (that restrained her to bed) represented an important sign, easily ignored in the obvious infectious context.