CLINICALLY SPEAKING Human Digit Partially Consumed by a Canine During Sleep in a Patient with Neuropathy and Diabetes Lee C. Rogers, DPM* Nicholas J. Bevilacqua, DPM* A traumatic amputation of a digit as a result of canine mastication and ingestion occurred in a 48-year-old woman with type 2 diabetes and peripheral neuropathy. The injury occurred during sleep and was not felt by the patient. The dangers of sleeping with one’s canine for those with neuropathic wounds are presented, and the literature is reviewed. (J Am Podiatr Med Assoc 101(3): 275-276, 2011) An estimated 2 million animal bites occur in the United States annually. Dogs and cats inflict 90% of those bites. 1 In adults, 75% of bites occur on the extremities, 2 with 50% on the lower extremities. 3 Most often, the animal is known to the victim. The oral flora of the dog commonly contains Staphylo- coccus aureus, Pasteurella multocida, coagulase- negative staphylococci, streptococci, Capnocyto- phaga canimorsus, corynebacteria, enterobacteria, Neisseria, and bacillus. 1 Only 15% to 20% of dog bites become infected, but infections are most often polymicrobial when they occur. 4 There is increased concern about the asymptom- atic carriage of methicillin-resistant S aureus in the oral flora of dogs and the possibility of transmission to humans. 5-7 A case report of a diabetic patient with recurrent methicillin-resistant S aureus infec- tion in the lower extremity despite treatment and attempted decolonization revealed that the family Dalmatian was the reservoir. The family admitted to sleeping with the dog and allowing it to lick their faces and hands. The dog required methicillin- resistant S aureus decolonization, which resulted in no infectious recurrences in the family. 8 Canines have been known to consume a digit, leading to amputation in someone with diabetes. 9 Donate et al 10 reported two interesting cases of dog bites to the lower extremity, one that caused an infection with methicillin-resistant S aureus and another that occurred during sleep in a diabetic person with neuropathy. Potempa and Lichty 11 de- scribed a case of a neglected dog bite to the hallux in a patient with diabetes that necessitated amputation. The behavior of the canines in these cases is rarely aggressive. The canines are, instead, consum- ing the flesh of the neuropathic patient, who has no painful reaction to bites. In all of the cases described, there was a wound or an infection already present, which perhaps attracted the dog by their keen sense of smell. Paul Wilson Brand, MD, medical missionary to India and author of Pain: The Gift Nobody Wants, in many lectures similarly described cases of animal-consumed digits in which lepers with neuropathy would arise after sleep to find their toes or fingers having been nibbled on by rats. Case Study A 48-year-old woman with type 2 diabetes presented to the emergency department at Broadlawns Med- ical Center in Des Moines, Iowa, via ambulance after waking to find her left hallux ‘‘shredded.’’ The paramedics reported a significant but unquantifiable amount of blood in her bed and on the floor. Her medical history also included hypertension, hyper- lipidemia, glaucoma, peripheral neuropathy, and a below-the-knee amputation on the right. The left hallux was examined and found to be missing the distal pulp and much of the soft tissue medial to the distal phalanx. The distal phalanx and interphalan- geal joint were exposed, and the periosteum was removed. The periwound tissue appeared torn and ecchymotic (Fig. 1). There was active bleeding, but no arterial bleeding. There were no signs of *Broadlawns Medical Center, Des Moines, Iowa. Dr. Rogers is now with Amputation Prevention Center, Valley Presbyterian Hospital, Los Angeles, CA. Dr. Bevilacqua is now with North Jersey Orthopaedic Specialists, Teaneck, NJ. Corresponding author: Lee C. Rogers, DPM, Amputation Prevention Center, Valley Presbyterian Hospital, 15107 Vanowen St, Los Angeles, CA 91405. (E-mail: Lee.C. Rogers@gmail.com) Journal of the American Podiatric Medical Association  Vol 101  No 3  May/June 2011 275