Combined therapy in a patient with a dissatisfactory metabolic compensation of type 2 diabetes mellitus
Abstract
The extreme obesity is associated with a high morbidity and mortality of affected people as well as with high demands on the health care, in which a limited use of many diagnostic methods is an important aspect. Limitations of instrumental methods are caused by technical parameters that avoid the examination of extremely obese patients or the examination brings only deficient profit.
A 53 years old woman with type 2 diabetes mellitus was admitted for signs and symptoms of a systemic inflammatory response with a baseline value of C-reactive protein (CRP) 290 mg/L. Simultaneously with the examination of the anticipated source of inflammation the patient was treated with antibiotics that were, particularly initially, effective, but it was not possible to achieve a complete elimination of the inflammation.
The results of neither cultures nor imaging methods clarified the source of the inflammation. In fact, the asymptomatic patient had subcutaneous abscess in venter pendulum, which exceeded the area examined during the abdominal CT scan.
In extremely obese patients the increase of inflammatory markers requires a very careful physical examination and consistent interpretation of the results of imaging methods; and it is essential to consider the possibility of systemic infection spreading from cutaneous or subcutaneous area in such patients.