International Journal of Surgical Research 2013, 2(4): 31-33 DOI: 10.5923/j.surgery.20130204.01 Ruptured Right Gluteal Abscess with Type II Diabetes Mellitus Andee Dzulkarnaen Zakaria 1,* , Wan Zainira 1 , Syed Hassan 1 , Mohamad Sadiq Abdul Rashid 2 , Tanvee r Azam 2 , Amer Hayat Khan 2 1 Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kelantan, Malaysia 2 Department of Clinical Pharmacy, School of Pharmaceutical Sciences Universiti Sains Malaysia, Penang, 11800, Malaysia Abstract Ruptured Gluteal abscess of unknown origin is not common in diabetic individuals. We report a case of gluteal abscess due to the non-compliance. Patient was 59 years old male with sign of ketoacidosis. Primarily patient was admitted due to disorientation and constitutional symptoms with lethargic feeling. Physicians observed an abscess on the buttock on examination when patient showed signs of restlessness and anxiety. The patient was treated successfully for surgical abscess drainage and a six week therapeutic regimen including tramadol, and Ampicillin and sulbactum were given to counter the infection. Treating an abscess in diabetic navies needs a complete follow up plan to avoid any opertunisic infection. Keywords Gluteal Abscess, Soft Tissue Infection, Diabetes Mellitus 1. Introduction Accumulation of fluid in tissue due to the inflammatory process secondary to any infection is known as abscess. Foremost, abscess appears as a hard lump surrounded by inflamed tissue with a feeling of warmth and pain. Abscess can appear in any tissue region. Pelvic abscess can be result of intramuscular injection, trauma or colon surgery[1, 2]. Pseudomonas, Klebsiella, E. Coli, Staphylococcus lugdunensis, Staphylococcus aureus, M. chelonae, M. fortuitum and M. abscessus are important microorganisms that are associated with gluteal abscess[1, 3]. Gluteal abscess grow in perianal area and are formed under the skin on the subcutaneous plane of the buttock muscle, secondary to any infection[4]. Injecting drug user are more likely develop gluteal abscess due to the unhygienic injection[5, 6]. Immunocompromised and diabetic individuals remain at high risk of developing bacterial infections and management of such infection needs an aggressive treatment approach[7]. Gluteal abscess is uncommon in such individual[8]. We are presenting a case of gluteal abscess in a diabetic naive without any known cause. 2. Case Presentation A 59 year male presented with chief complaint of pain at the site of gluteal swelling for two weeks with regular pus * Corresponding author: andee@kb.usm.my (Andee Dzulkarnaen Zakaria) Published online at http://journal.sapub.org/surgery Copyright © 2013 Scientific & Academic Publishing. All Rights Reserved discharge and low grade fever. Patient had type II diabetes for 12 years and history of treatment for unstable angina. Random blood glucose level (BGL) was 27.8 mmol/l with high blood pressure (161/92) and normal body temperature, upon arrival. Patient was already prescribed with Isordil 10mg, Antrapid 14u, 1000u/H, Aspirine 150mg, clopidogrel, Atrovastatin, insulatard 14u, Ramipril 5mg and bisoprolol 2.5mg. However, patient was noncompliant to his medication. When admitted, patient was lethargic with stable physical profiles. Clinical examination revealed a tender swelling on right gluteal region measuring 10 x 10 cm. Laboratory investigations showed a normal blood picture except a slight increase in white blood count. Moreover, chest and spine X-ray were both clear. Operation was considered for pus drainage from gluteal swelling. Sliding scale insulin regimens was started to lower the BGL and patient was further initiated on metformin, Ampicillin and sulbactum were indicated for abscess while tramadol for pain. About 23cc pus was aspirated under general anaesthesia and was sent for pathology examination. Therapy was continued with insulin, metformin, tramadol, Ampicillin and sulbactum, atorvastatin with regular dressing change. Patient recovered completely after six weeks fallow up and was discharged from the hospital. Proper counselling was provided to the patient about use of medication to avoid future complications. 3. Discussion Diabetic patients remain at risk of developing soft tissue infection[9]. Patient in this case was non-compliant to his medication, had a high blood glucose level and hence, was at