Necrotizing fasciitis in a woman with a diabetic foot infection and peripheral neuropathy

We report the case of a 62-year-old African American woman with poorly controlled diabetes who presented with the complaint of not being able to remove her stockings from her left foot. The patient had long-standing peripheral neuropathy from diabetes. Her physical examination in the emergency department was challenging because of extensive infection in her left lower extremity. Careful removal of the stockings resulted in the debridement of the lower third of her left leg and entire foot. Her laboratory findings were notable for a white blood cell count of 11.7 x 10(3) cells/mm(3) with 18% bands, an erythrocyte sedimentation rate of 100 mm/hour, and glycated hemoglobin of 11.5%. This case is unique in that the patient presented with both wet and dry gangrene of her lower extremities. We discuss the spectrum of infectious processes in diabetic foot infections and discuss the management of patients with necrotizing fasciitis.