Abstract
A 66-year old man suffered a toe ulcer in March 1992. We diagnosed his illness as diabetic gangrene and treated him on diet therapy, insulin therapy, antibiotics and local therapy. The lesion was cured within 6 weeks. After treatment, his blood glucose level became stable and his hemoglobin A1c level decreased gradually. Since late August he had remittent fever and a sense of fatigue. His right chest had moist rales. The white cell count was 15800/μl, and CRP was strongly positive. The chest X-ray film showed infiltrates in the right field, diagnosed as bacterial pneumonia. Although we administered broad-spectrum antibiotics, his fever remained unchanged and his chest X-ray film deteriorated. Every sputum culture showed normal flora. Because the condition had improved after changing antibiotics, we regarded his respiratory infection as lung tuberculosis and added anti-tubercle drugs. On the 14th day, he died suddenly of hypovolemic shock after vomiting. The culture of percutaneous lung biopsy specimen proved tubercle bacilli. The abdominal plain film showed dilatation of the stomach on the day of death. The acute dilatation of the stomach may have been due to decreased gastric excretion as a result of diabetic neuropathy in addition to deterioration of lung tuberculosis.
