Diabetes and associated s...

A 78-year-old man presented with a necrotic, unhealed wound in the medial malleolar area of the left leg for 2 weeks. He does not recall a history of trauma to his lower extremities. He reported no fever, weight loss, or other constitutional symptoms. There was only mild pain of the wound. He had diabetes mellitus for which oral hypoglycemic agents were prescribed for a few years. The blood sugar was not well controlled. At admission, the non-fasting sugar was 334 mg/dL. He denied other illnesses and the remainder of the physical examination was unremarkable. After admission, a skin biopsy was taken followed by debridement of the ulcer. After removing the overlying crust, a large wound was found underneath. Microscopic examination of the skin tissue showed the presence of angioinvasive hyphae. Subsequently, non-septate, right-angle branching hyphae were demonstrated by periodic acid-Schiff (PAS) stain. The tissue culture was positive for Rhizopus spp.