Author(s): *Rigopoulos N., Zalavras C.G., Poultsides A., Patzakis M.J.; LAC+USC Medical Center, Los Angeles,CA
Title: Deep thigh abscesses in patients with diabetes mellitus.
Purpose: Deep thigh abscesses have not been described in diabetic patients, despite their predisposition to infection. The purpose of this study was to describe the clinical features of this complication and alert the treating physician to its presence.
Methods: This retrospective study included adult patients with diabetes mellitus treated at our institution for a deep thigh abscess. There were 32 patients, 24 male and 8 female, with a mean age of 45 years (range, 26-67 years). The mean blood glucose levels on admission were 242 mg/dl (range, 105-402 mg/dl). Thirty patients were aware of the diagnosis of diabetes mellitus but in 2 patients diabetes mellitus was diagnosed upon admission. Additional comorbidities were present in 13 patients, including intravenous drug abuse in 4 patients.
Results: The presence of an abscess was clinically apparent in only 9 of 32 patients (28%) with fluctuance in 6 and purulent drainage in 3 patients. The remaining 23 patients demonstrated swelling and tenderness but no fluctuance over the involved area and were initially diagnosed with cellulitis, resulting in delayed surgical management. The mean delay from onset of symptoms to surgery was 16 days (range, 2-38 days) and prior to management two patients developed septic shock and one patient developed diabetic ketoacidosis. All patients underwent operative drainage of the abscess, irrigation, and debridement. Necrotic muscle was present in 15 patients. Twenty-one patients required more than one debridement procedure.
Discussion: Deep thigh abscesses in diabetic patients may go undetected and surgical management may be delayed. A high index of suspicion is warranted whenever symptoms and signs of inflammation are localized at the thigh area in patients with diabetes mellitus.