A rare case of purulent leptomeningitis in type 2 diabetes mellitus

Abstract

Purulent-septic complications in patients with type 2 diabetes mellitus (DM) do not tend to decrease and vary from 15 to 49%. About 50% of all patients with DM are at risk. Objective: to describe a rare case of purulent leptomeningitis in a patient with type 2 DM. Material and methods. A comparison of data based on the results of clinical analysis and autopsy was carried out. Histological material is stained with hematoxylin and eosin. Results. A 62-year-old patient who died at home lived alone. From the outpatient card records (last visit to a therapist on July 22, 2024), the diagnosis was: DM, type 2: diabetic macromicroangiopathy. The patient’s immune reactivity index (IRI) is within normal limits and is 7.1. The lymphocyte index is reduced to 0.2. The patient died on 10/28/2024 with symptoms of multiple organ failure. Due to the statement of death, the body was sent for autopsy. Examination of the brain reveals vascular congestion with small thrombi, the pia mater is diffusely infiltrated with polymorphonuclear leukocytes. Perivascular and pericellular edema of the brain is determined. Interlobular and periductal sclerosis, subatrophic and atrophic changes in the insular apparatus are detected in the pancreas. The vessel walls are hyalinized and sclerosed. Conclusion. In the presented case, the determining factor in the development of purulent leptomeningitis and the onset of death of the patient was diabetes. Despite the fact that several months before death, the IIR was within normal values, the lymphocyte index was significantly reduced.