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• W2023668081 abstract "A40-year-old white caucasian female presented to the Emergency Medicine unit with a one-week history of constant, dull left upper quadrant pain together with dysuria, polyuria and polydipsia. Her family doctor had commenced treatment for a suspected urinary tract infection. During the last two days, the pain had worsened and was now associated with nausea and vomiting. The patient also admitted to weight loss (12 kg) in the last three months. She had an otherwise unremarkable medical history and family history did not reveal anything significant. She did not use any regular medications, her smoking history was 20 packs/year and her alcohol intake was moderate. On examination the patient was dehydrated and pyrexial (39.5oC). Her vital signs were: blood pressure 135/85 mmHg, pulse 105 bpm, and respiratory rate of 20/minute. Abdominal examination revealed moderate tenderness in the left lumbar region. Closer examination of the extremities revealed a non-tender brown ring-shaped papule on the left wrist measuring 12 mm in diameter with a darker depressed centre (figure 1). The patient had first noticed this lesion approximately three months ago. The rest of the examination, including fundoscopy, was normal. Urine dipstick revealed glycosuria, ketonuria and the presence of blood. Blood tests revealed: random glucose = 17.4 mmol/L, white cell count = 25.33 x 10/L (neutrophils 20.83 x 10/L) and normal urea and electrolyte levels. Arterial blood gas sample did not reveal acidosis and blood cultures showed no growth. Mid stream urine culture revealed significant growth of E.coli (> 10 colony forming units/mL). The patient was started on an insulin sliding scale and intravenous cefuroxime. However, the patient’s pyrexia failed to resolve and 72 hours later examination revealed a subtle tender swelling (3 x 4 cm) in the left lumbar region. A computerised tomography (CT) scan confirmed bilateral pyelonephritis with early perinephric abscess formation (figure 2) – but not yet suitable for drainage. Intravenous antibiotic therapy was altered to include flucloxacillin and repeat CT scan five and 15 days later confirmed satisfactory resolution. Discussion Granuloma annulare is a benign condition characterised by focal degeneration of collagen with surrounding areas of reactive inflammation and fibrosis. Although the cause of granuloma annulare remains unclear, cases of granuloma annulare have been reported following trauma, viral infections such as HIV, autoimmune thyroid disease and malignancy. Although some researchers have concluded that there is no correlation between granuloma annulare and diabetes mellitus, others have shown a definite association. Granuloma annulare can occur at any age. It is commoner in children, but the correlation with diabetes is higher in adults. Clinically, it most commonly presents in the localised form but Granuloma annulare and perinephric abscess in undiagnosed diabetes mellitus" @default.
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• W2023668081 date "2003-11-01" @default.
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• W2023668081 title "Granuloma annulare and perinephric abscess in undiagnosed diabetes mellitus" @default.
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• W2023668081 doi "https://doi.org/10.1177/14746514030030060901" @default.
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