Necrotizing Fasciitis Following Intramuscular Self-Injection of Insulin

Regular follow-up and communication was maintained with the patient. We noted the emergence of a wound on her right buttocks, post self-injection of subcutaneous insulin. The patient stated that she experienced heavy bruising in her abdominal area, which motivated her to self-inject the insulin in her right buttock. Patient pursued wound checks on the developing cellulitis at her local community clinic every 2 days for about 1 week. Wound culture was positive for moderate Staphylococcus aureus. Treatment regimen included Clindamycin 300 mg, 2 capsules every 8 hours. Despite the antibiotic regimen, the patient’s condition was deteriorating and her wound was showing signs of necrosis. She was referred to the emergency department, where she was found to be septic and started on broad-spectrum antibiotics. Immediate surgical intervention prompted an I&D. The patient was admitted post-op on an antibiotic regimen including Flagyl, Vancomycin, and Cefepime, and a wound vacuum. Home Health follows up with the patient every three days for wound vacuum maintenance and wound checks (Figure 1).