Endophthalmitis and subretinal abscess complicating diabetic
The present case has been published in BMJ. A 26-year-old man with type 1 diabetes, diagnosed at aged 14, presented to the emergency department with shortness of breath as well as left flank pain. The patient was taking a basal-bolus (Actrapid/Lantus) regimen of insulin and had no other medical conditions.

The patient was found to be in diabetic ketoacidosis (blood glucose level 21 mmol/L, pH 7.10) and diagnosed with chest sepsis based on bilateral consolidation on a chest X-ray. The patient was admitted to the high dependency unit and treated empirically with intravenous flucloxacillin and ceftriaxone.

Blood cultures grew a fully sensitive Staphylococcus aureus. The patient’s flank pain failed to improve and on day 3 of admission CT of the abdomen and pelvis demonstrated a left 4.9 cm intermedius muscle abscess.

There were additional small focal collections in the left psoas, right psoas and right erector spinae muscle. Radiologically guided aspiration of the left intermedius collection demonstrated the same S. aureus growth. Echocardiogram, as well as tests for HIV, blood film and tuberculosis, was normal.

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