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A touch of athlete’s foot?
An uncommon diabetic presentation
A brief history
• 51 year old male
PC: Painful swollen left foot
• 2/12 prior to admission, went
walking in Amsterdam on cobbles
causing bruised feet.
• 10/7 prior to admission, noticed
that foot was becoming slightly
painful and erythematous.
• 1/7 prior to admission, presented to Weston S-Mare A+E
– Foot swollen and tender, small area of erythema
– BM 22
– Admission debated, but patient eventually given oral Pen V and Fluclox
and told to attend GP on Monday after weekend.
• Following day came down to Torquay!
• Foot increasingly tender and swollen -> A+E
• On direct questioning:
– No polydypsia
– Normally polyuric but on frusemide.
– Had noticed increased weight loss over previous two years but had been
– Denied any awareness of loss of sensation in feet or neuropathic Sx.
• Atenolol 50mg OD
• Enalapril 40mg OD
• Frusemide 40mg OD
• Non smoker
• ETOH – up to 20units/week
• Pyrexial Temp 38°C
• Chest: NAD
• Abdo: NAD
• Legs: Swollen discoloured left foot
Area of cellulitis over left shin
• Fundoscopy showed small micro aneurysms near point of
• WCC 15
• HB 17.0
• PLT 173
• Na 131
• K 4.8
• Ur 7.1
• Cr 105
• Glu 22.5 •Group B Streptococci
• Ketones Trace
•Light growth of anaerobes
• IV Antibiotics:
– Benzylpenicillin 2.4g QDS
– Flucloxacillin 1g QDS
– Metronidazole 500mg TDS
• Initially on insulin sliding scale but converted to QDS regime on
• Diabetes Specialist Nurse review
• Dietician review
• Retinal screening