PMC5926487_01
Upper back demonstrating thickened skin after incision and drainage.
CRIE2018-9513768.001.jpg
PMC5926487_01_CRIE2018-9513768.001.jpg
fig1
His physical examination was significant for an extensive area of induration in the right upper back extending into the back of the neck, measured about 25 cm x 20 cm in size, and had a 3 cm x 4 cm x 3 cm area of fluctuation with erythema and tenderness (Figure 1). His laboratory investigations were significant for leukocytosis with a white blood cell count of 26,000/muL, lactic acidosis with a serum lactic acid of 2.4 mmol/L (normal 0.5-1.9 mmol/L) and serum bicarbonate of 16 mmol/L (normal 22-32 mmol/L), and poorly controlled diabetes with serum glucose of 291 mg/dL (normal 74-118 mg/dL) and subsequent hemoglobin A1C of 10.3% (normal 4.8%-5.6%).
CT scan of the chest showing a large area of subcutaneous tissue density of right upper back.
CRIE2018-9513768.002.jpg
PMC5926487_01_CRIE2018-9513768.002.jpg
fig2
Chest imaging showed bullous changes in the upper lobes of the lung, a large area of soft tissue density in the subcutaneous tissue of right upper back, and enlarged right trapezius muscle (Figure 2).
Histopathology from skin biopsy of the upper back showing fibroadipose tissue and skeletal muscle with focal acute and chronic inflammation.
CRIE2018-9513768.003.jpg
PMC5926487_01_CRIE2018-9513768.003.jpg
fig3
A skin biopsy taken from the back was sent for histopathology and showed fibroadipose tissue and skeletal muscle with focal acute and chronic inflammation with granulation tissue (Figure 3).