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?本病例摘自2013年12月5日刊《新英格兰医学杂志》： Evolution of a Diabetic Foot Infection 糖尿病足感染的临床演进 An obese 50-year-old man with no known medical history presented with a necrotizing infection of his right foot that had begun 10 days previously with lesions that he attributed to wearing new shoes. He was found to have diabetes (glycated hemoglobin level, 10.5%) with peripheral neuropathy; he was afebrile, without leukocytosis or radiographic evidence of bone involvement in his right foot. The patient had photographed the lesion twice daily, thinking it would heal spontaneously (Panel A). The preoperative photographs show erythema (day 1), blisters (day 3), a necrotizing abscess (day 6), and wound infection requiring surgery (day 10). The patient underwent operative débridement; tissue cultures grew Enterobacter cloacae and Streptococcus agalactiae. He was treated with antibiotic agents for 3 weeks. The infection resolved, with no recurrence or sequelae during 3 years of follow-up (Panel B); during this period, the infection-related swelling disappeared and the patient lost a considerable amount of weight. Diabetic foot infection may evolve rapidly, especially in patients with neuropathy. 50岁男，平素健康，右脚坏死性感染10天。脚步受损原因为新鞋不合脚。患者被证实患有糖尿病（糖化血红蛋白值，10.5%），同时合并外周神经病变。患者无发热，实验室检查未发现白细胞计数增高，右脚的放射线检查未见病灶累及骨骼。患者每天给病灶拍照两次，并认为伤口可自行愈合（O__O'… ，见图A）。手术前的照片显示水肿（第一天），水疱（第三天），脓肿合并坏死（第六天），以及需要进行手术治疗的感染恶化（第十天）。清创术后的细菌培养证实阴沟肠杆菌和无乳链球菌阳性。接受抗生素治疗3周。治疗后的感染好转，随访3年期间未见复发或留有后遗症（图B）。随访期间，感染灶相关的肿胀消失，患者亦积极减肥出现明显体重下降。合并外周神经病变的糖尿病足可迅速发展。 |
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