Inherent defects in white cell function in combination with local complications of diabetes mellitus place the diabetic patient at higher risk for infection. A spectrum of rare but serious infections is seen primarily in diabetics. Mucormycosis is an aggressive fungal infection; rhinocerebral disease is most commonly seen in diabetics. Necrotizing fasciitis is a severe, often rapidly progressive soft tissue infection due to multiple aerobic and anaerobic microorganisms. Malignant external otitis is an indolent infection with serious sequelae, including osteomyelitis and cranial neuropathies. Emphysematous pyelonephritis is a destructive renal infection, usually requiring nephrectomy for adequate treatment. Despite the diversity of these infections, they have at least one feature in common: all require prompt and aggressive surgical debridement for optimal outcome. The clinical presentation, diagnosis, and management of these four infectious processes are discussed in this review.
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