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\begin{document}

\title{Mistreatment of Diabetic Foot Ulcer with Leech therapy caused Necrotic
fasciitis and Amputation}



\author[1]{Mostafa Javanian}%
\author[1]{rahim rajabi}%
\author[1]{Sara Mohammadnia}%
\author[1]{Soheil Ebrahimpour}%
\affil[1]{Babol University of Medical Science}%


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  \date{March 14, 2025}


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\textbf{Manuscript title: Mistreatment of Diabetic Foot Ulcer with Leech
therapy caused Necrotic Fasciitis and Amputation}

\textbf{Short title: Necrotic Fasciitis, Leech therapy}

\textbf{Key clinical message}

A diabetic foot ulcer is a common complication in diabetes patients.
Different methods are used to manage the ulcer such as leech therapy.
This therapy may have some noticeable complications like Necrotic
Fasciitis.

\textbf{Keywords} : Leach therapy, Diabetes mellitus, Diabetic foot
ulcer, Mistreatment

\textbf{Case Report}

A 72-year-old woman with a history of Diabetes mellitus was admitted to
the hospital with loss of consciousness and Diabetic Foot Ulcer (DFU) on
her right leg on June 26\textsuperscript{th}, 2023 (Figure 1). According
to what her family said; one month ago, she was admitted to the
hospital, and right leg amputation was recommended for her but she
decided not to follow the recommendation and left the hospital. She got
leech therapy two days ago, and after the therapy, the wounds started
bleeding and the night before admission she started losing
consciousness.

On admission Blood pressure was at 135/75 mmHg, Respiratory rate was at
24 per minute, Pulse Rate was at 110 pulse/minute and the temperature
was at 37.1\selectlanguage{ngerman}° centigrade.

In physical examination, she was lethargic but was oriented to time and
place. It was noted that crepitation in the wound has been extended to
the knee.

A color Doppler ultrasonography in the evaluation of the DFU showed a
monophasic arterial flow pattern, atherosclerotic plaques throughout the
artery, and gas in foot muscle sheets from ankle to knee which was seen
in X-Ray, too (figure 2).

Lab data on admission reported C-reactive protein at 219 mg/L, Withe
blood cell count at 20000 per \selectlanguage{greek}µ\selectlanguage{english}L, and platelet count at 410000 per \selectlanguage{greek}µ\selectlanguage{english}L.
The urine culture showed no growth of bacteria after 24 hours.

The patient was given Meropenem injections (1g, BD) and Linezolid
injections (600g, BD) with Vitamin B6 orally (BD).

Due to the evidence, the patient was diagnosed with Necrotic fasciitis
and got transfemoral amputation (figure 3).\selectlanguage{english}
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Figure 1: DFU\selectlanguage{english}
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Figure 2: X-Ray of the area\selectlanguage{english}
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Figure 3: After Amputation

\textbf{Discussion~}

One of the most important complications of Diabetic Mellitus (DM) is
Diabetic Foot Ulcer (DFU). A significant number of the patients
diagnosed with Diabetic Mellitus would experience DFU (1).

Necrotic Fasciitis that can be developed in a DFU is a rare but
dangerous infectious disease of soft tissue (2).

Leech therapy as a treatment method for Diabetic Foot Ulcer may have
complications, such as Bleeding; which can be controlled by topical
thrombin and pressure; if not, blood transfusion can be helpful,
Allergic responses and scarring. \emph{Aeromonas hydrophilia,~} a
Gram-negative bacterium in a leech's digestive system can lead to
abscesses, cellulitis, and sepsis if it's not developed in a standard
criteria (3).

\textbf{Conflict of interest}

None.

\textbf{Funding information}

None.

\textbf{Consent}

Written informed consent was obtained from the patient to publish the
current case report.

1. Rahimi K, Hosseinpour L, Balaneji SM, Goli R, Faraji N, Babamiri B.
Large wound surgery of diabetic foot ulcer with Split-thickness skin
graft (STSG), and maggot debridement therapy (MDT): A case report.
International Journal of Surgery Case Reports. 2023;104:107947.

2. Okhunov A, Korikhonov D. Differential diagnosis of necrotizing
fasciitis. British Medical Journal. 2023;3(1).

3. Spear M. Medicinal leech therapy: Friend or foe. Plastic and
Aesthetic Nursing. 2016;36(3):121-5.\selectlanguage{english}
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\includegraphics[width=0.70\columnwidth]{figures/photo-2023-07-13-13-01-26/photo-2023-07-13-13-01-26}

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