A 43-year-old Japanese woman was referred to our hospital for a 3-week history of swelling on the right buttock. Physical examination revealed swelling and erythema with tenderness on the buttocks and a small ulcer on her right perineum (Figure 1). She had a slight fever (temperature, 37.5°C). Results of laboratory tests were as follows: leukocyte count, 19 200/μL; creatine phosphokinase, 49 IU/L; serum glucose, 482 mg/dL; hemoglobin A1c, 15.2%; and C-reactive protein, 203.0 mg/L. (To convert leukocyte count to number of cells × 109/L, multiply by 0.001; to convert serum glucose to millimoles per liter, multiply by 0.0555; to convert hemoglobin to proportion of total hemoglobin, multiply by 0.01; to convert C-reactive protein to nanomoles per liter, multiply by 9.524.) She was not aware of having severe diabetes mellitus. Magnetic resonance imaging showed nodular densities within subcutaneous fat tissue (Figure 2). Culture grown from pus on the lesion proved positive for Candida species. Based on these findings, necrotizing soft-tissue infection caused by fungus was suspected.
Shindo M, Yoshida Y, Adachi K, Nakashima K, Watanabe T, Yamamoto O. Necrotizing Soft-Tissue Infection Caused by Both Candida glabrata and Streptococcus agalactiae. Arch Dermatol. 2009;145(1):96-97. doi:10.1001/archderm.145.1.96