A case of bilateral pulmonary suppuration with multiple cavities in a type 1 diabetic hemodialysis patient

Abstract

The case was a 61-year-old female. She developed type 1 diabetes at the age of 21 and started intensive insulin therapy. She began hemodialysis at the age of 56 because of end-stage renal failure due to diabetic kidney disease. Her endogenous insulin secretion was depleted, and glycemic control was very unstable even with intensive insulin therapy, and so she wore a flash glucose monitor (FGM). She was admitted to our hospital because she complained of respiratory distress during dialysis. She was diagnosed with pneumonia because chest CT showed multiple infiltrative shadows in the lungs. After starting treatment with antibiotics, she showed multiple cavities on chest CT on the 10th day of the illness, and was diagnosed with pulmonary suppuration. Pulmonary suppuration rarely spreads over multiple lobes, being generally confined to a single lobe. In the present case, the rapid and extensive development of lung abscesses may have been caused by type 1 diabetes mellitus with high blood glucose variability, which was characteristic of this patient, and may have been related to subclinical aspiration at the same time. To our knowledge, based on a literature review, similar case reports have not been reported to date, and so this is reported as a valuable case.