J Diabetol 2018 Volume 2 Issue 1 1 http://www.alliedacademies.org/journal-diabetology/ Case Report Severe septic complications in a diabetic foot decades after multiple injections of a modeling agent. Cueto J 1* , Barrientos T 2 , Ochoa R 2 , Bert E 2 , Ibarra J 2 , Moreno MA 3 , Aparicio G 4 1 Department of Surgery of the American British Hospital and the Research Department of Anahuac University, Mexico City, Mexico 2 Research Department of Anahuac University, Mexico City, Mexico 3 Immunobiology Laboratory, Juarez Hospital Mexico, Ministry of Health, Mexico City, Mexico 4 Department of Microbiology, National Polytechnic Institute, Mexico Case Report HPI: Mrs. A. G.L. a 57-year-old. a white Caucasian female, was seen in the office on March 11th, 2015 with a history of T2D for more than 10 years. The patient was adequately controlled with 12 U of insulin daily and followed her diabetic diet. She informed us that in August 2015 noticed discomfort and pain in her right leg and ankle with redness and swelling. She consulted 2 angiologists whom applied several creams and dressings and prescribed antibiotics without improvement of the lesions. She was told that an amputation could probably had to be done. The patient also reported that "25 years ago a female cosmetologist applied 22 injections in each leg of a modeling agent, probably silicon” and that to date they had not caused any alteration." Initial examination revealed a pale female patient complaining of pain in the right leg. She had normal and stable vital signs and physical examination revealed alterations in both pelvic limbs. In the right leg and ankle, extensive cellulitis with necrosis was found from the lower third of the inner side of the leg to the ankle (Figures 1 and 2). There was intense pain on palpation in these lesions. No pulses were felt nor there was a positive signal with the Doppler system in any of the lower extremities below the popliteal region. Neurological examination revealed extensive areas of neuropathy mainly in the plantar and distal areas of the right foot. Analgesics were administered, blood samples were taken as well as radiographs of the right foot and leg that ruled out evidence of osteomyelitis. The glucose was 124 mg% and the glycosylated Hgb was 11.1 mg%, hemoglobin 10.4 g%, with leukocytosis of 17,000 mm 3 and a creatinine of 1.6 mg% and the seriousness of the situation was explained to the patient whom authorized an initial urgent debridement. Ketorolac 30 mg I.M. was applied and a 3 cm incision was made and 10 ml of malodorous dark pus was drained and samples were sent for aerobic and anaerobic cultures and sensitivities. Moxifloxacin 400 mg P.O. daily was prescribed, and the patient was instructed to wash the affected area every morning and apply Pebisut®* once a day and return to consultation in 48 h. The culture was positive for Staphylococcus Aureus Coagulase Positive and Escherichia coli, both of which were resistant to most of the commonly prescribed antibiotics. A definite Diabetic foot (DF) is a grave macro and microvascular diabetic complication that consists of different types of lesions in tissues harboring severe neuropathy and ischemia. The incidence of diabetic foot has increased due to the worldwide prevalence of diabetes mellitus, the prolonged life expectancy of patients and the increased prevalence of obesity. In fact, according to the WHO projections, “diabetes will be the seventh cause of mortality in 2030". Currently, women and men alike constantly try to improve personal appearance, whether due to a deformity or pure aesthetics. As a consequence of the lack of knowledge, non-qualified health personnel offer dubious surgical techniques, which they claim to be safe and economical, which consist of injecting different modeling agents, but the indiscriminate uncontrolled use of many types of such fillers applied in different manners have produced very serious and even fatal complications. In the case herein reported such a dangerous complication was observed and treated in an adult female who received multiple bilateral injections of a modeling agent. Abstract Keywords: Diabetic foot, insulin, glucose. Accepted on March 19, 2018 Figure 1: Cellulitis and several areas of necrosis in the right leg. * Patents: USPTO, USA, #8,252,333. Canada #2,661,686. European Union #2,062,602. Mexico #280,754. External application in Mexico, folio number assigned #59173 in August 2017, USA September 2017, Canada December 2017