To investigate the clinical characteristics, diagnosis and treatment of diabetic ketoacidosis (DKA) induced by skin soft tissue infection caused by Aspergillus fumigatus.

The clinical features, risk factors, diagnosis and treatment of a patient with DKA and Aspergillus fumigatus infection of skin and soft tissue as the first manifestation were analyzed in January 2022 in Traditional Chinese Hospital of Lu’an.

The patient, a 29-year-old male without history of diabetes, presented with a suppurative infection of the soft tissues of the back as the first manifestation. The patient was diagnosed as DKA by relevant examination on admission and received initial anti-infection treatment with piperacillin and tazobactam (4.5 g/time, intravenous infusion, once/8 h, course of treatment: 21 days). The patient’s purulent secretions were cultured for 3 days, suggesting Aspergillus fumigatus and was given antifungal therapy with voriconazole (200 mg/time, intravenous infusion, once/12 h, doubled on the first day, course of treatment: 19 days). After orthopedic consultation, the focus removal was performed. The histopathology showed that there were a lot of granulation tissue with necrosis. During the operation, the purulent tissue was cultured for 3 days and reported positive (Aspergillus fumigatus). After anti-infective treatment, the patient’s purulent lesion gradually shrank and was discharged successfully. During the operation, the purulent tissue was cultured for 3 days, which suggested Aspergillus fumigatus. After anti-infection treatment with piperacillin and tazobactam (4.5 g/time, intravenous infusion, once/8 h, course of treatment: 21 days) + voriconazole (200 mg/ time, intravenous infusion, once/12 h, course of treatment: 19 days), the patient was discharged successfully.

The suppurative infection of deep soft tissue caused by Aspergillus fumigatus is rarely reported, the clinical manifestations are not specific, and DKA is rare. For patients with underlying immune dysfunction complicated with soft tissue infection, the possibility of fungal infection should be considered combined with molecular biology and microbial culture, and early diagnosis and treatment should be considered to improve the prognosis.