{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T10:34:53Z","timestamp":1775039693151,"version":"3.50.1"},"reference-count":20,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background: Continuous glucose monitoring (CGM) systems have significantly improved glycemic management in patients with type 1 diabetes mellitus and are generally considered safe. However, transcutaneous sensor insertion disrupts the skin barrier and, in susceptible individuals, may contribute to infectious complications. Severe soft tissue infections occurring in temporal association with CGM use are exceedingly rare. Case Presentation: We report a fatal case of necrotizing soft tissue infection in a 54-year-old male with long-standing type 1 diabetes mellitus occurring in temporal association with CGM use. The patient initially developed localized inflammation at a prior sensor insertion site that failed to fully resolve. Over subsequent weeks, he experienced progressive systemic symptoms and worsening local findings, culminating in advanced necrotizing infection. Despite emergency surgical debridement, broad-spectrum antimicrobial therapy, and intensive care support, the clinical course was complicated by septic shock and multiorgan failure, resulting in death. Discussion: This case highlights the role of patient-specific vulnerability, persistent insertion-site inflammation, and delayed clinical recognition in the progression from localized skin changes to life-threatening infection. Importantly, this report does not establish a direct causal relationship between CGM use and necrotizing soft tissue infection but underscores the need for heightened vigilance in high-risk individuals. Conclusions: Although CGM systems have a favorable safety profile, careful inspection of insertion sites, avoidance of sensor reapplication over incompletely healed tissue, and early evaluation of persistent or progressive symptoms are essential to minimize the risk of severe outcomes in susceptible patients.<\/jats:p>","DOI":"10.3390\/diseases14040124","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T16:34:08Z","timestamp":1774974848000},"page":"124","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fatal Necrotizing Soft Tissue Infection Following Continuous Glucose Monitoring in a Patient with Type 1 Diabetes: A Case Report and Literature Review"],"prefix":"10.3390","volume":"14","author":[{"given":"Constantin","family":"Popazu","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Pharmacy, Research Centre in the Medical-Pharmaceutical Field, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 800201 Gala\u021bi, Romania"},{"name":"County Emergency Clinical Hospital of Br\u0103ila, 810325 Br\u0103ila, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristiana","family":"Voineag","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, Research Centre in the Medical-Pharmaceutical Field, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 800201 Gala\u021bi, Romania"},{"name":"County Emergency Clinical Hospital of Br\u0103ila, 810325 Br\u0103ila, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3627-0486","authenticated-orcid":false,"given":"Ionica","family":"Grigore","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, Research Centre in the Medical-Pharmaceutical Field, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 800201 Gala\u021bi, Romania"},{"name":"County Emergency Clinical Hospital of Br\u0103ila, 810325 Br\u0103ila, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"\u0218erban","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, Research Centre in the Medical-Pharmaceutical Field, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 800201 Gala\u021bi, Romania"},{"name":"\u201cSf. Apostol Andrei\u201d County Emergency Clinical Hospital Gala\u021bi, 800578 Gala\u021bi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M\u0103d\u0103lin","family":"Guliciuc","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, Research Centre in the Medical-Pharmaceutical Field, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 800201 Gala\u021bi, Romania"},{"name":"\u201cSf. Apostol Andrei\u201d County Emergency Clinical Hospital Gala\u021bi, 800578 Gala\u021bi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Drago\u0219","family":"Voicu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, Research Centre in the Medical-Pharmaceutical Field, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 800201 Gala\u021bi, Romania"},{"name":"County Emergency Clinical Hospital of Br\u0103ila, 810325 Br\u0103ila, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Toma","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, Research Centre in the Medical-Pharmaceutical Field, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 800201 Gala\u021bi, Romania"},{"name":"County Emergency Clinical Hospital of Br\u0103ila, 810325 Br\u0103ila, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1177\/1932296820918894","article-title":"Cutaneous reactions to continuous glucose monitoring and continuous subcutaneous insulin infusion devices in type 1 diabetes mellitus","volume":"15","author":"Rigo","year":"2021","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_2","first-page":"104","article-title":"Skin problems associated with insulin pumps and sensors","volume":"12","author":"Berg","year":"2018","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18103\/mra.v11i11.4747","article-title":"Skin problems due to treatment with diabetes technology: A narrative review","volume":"11","author":"Berg","year":"2023","journal-title":"Med. Res. Arch."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Cicho\u0144, M., Zdanowska, N., and Reich, A. (2023). Contact dermatitis to diabetes medical devices. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms241310697"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e59824","DOI":"10.2196\/59824","article-title":"Cutaneous adverse effects from diabetes devices in children and adults: A systematic review","volume":"7","author":"Podwojniak","year":"2024","journal-title":"JMIR Dermatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1097\/DER.0000000000000861","article-title":"Allergic contact dermatitis in users of diabetes devices: A systematic review","volume":"33","author":"Cameli","year":"2022","journal-title":"Dermatitis"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s40257-018-0400-7","article-title":"Cutaneous adverse effects of diabetes mellitus medications and medical devices","volume":"20","author":"Jedlowski","year":"2019","journal-title":"Am. J. Clin. Dermatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1111\/cod.14698","article-title":"Allergic contact dermatitis caused by glucose sensors and insulin pumps: A full review: Part 1: Sensors and pumps, adverse cutaneous reactions, allergens, and diabetes devices causing allergic contact dermatitis","volume":"92","author":"Ipenburg","year":"2025","journal-title":"Contact Dermat."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1093\/qjmed\/hcaa123","article-title":"Streptococcus pyogenes necrotizing soft tissue infection following glucose monitoring with FreeStyle Libre device","volume":"114","author":"Galperine","year":"2021","journal-title":"QJM Int. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/j.jcjd.2020.11.009","article-title":"Scarlet Fever After Streptococcus pyogenes Skin Infection Associated With FreeStyle Libre Glucose Monitoring","volume":"45","author":"Dyminska","year":"2021","journal-title":"Can. J. Diabetes."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"429","DOI":"10.2337\/cd20-0043","article-title":"Miller; Using Continuous Glucose Monitoring in Clinical Practice","volume":"38","author":"Eden","year":"2020","journal-title":"Clin. Diabetes"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S27","DOI":"10.4103\/2230-8210.94253","article-title":"Infections in patients with diabetes mellitus: A review of pathogenesis","volume":"16","author":"Casqueiro","year":"2012","journal-title":"Indian J. Endocrinol. Metab."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1007\/s00125-024-06102-x","article-title":"Diabetes and infection: Review of the epidemiology, mechanisms and principles of treatment","volume":"67","author":"Holt","year":"2024","journal-title":"Diabetologia"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"108732","DOI":"10.1016\/j.diabres.2021.108732","article-title":"Diabetes and acute bacterial skin and skin structure infections","volume":"174","author":"Falcone","year":"2021","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Cheng, S., Poh, B.R.-M., Tay, V.W.Y., Lee, P.P., and Mathur, S. (2024). The interplay between diabetes Mellitus and soft tissue infections in general surgical patients. BMC Endocr. Disord., 24.","DOI":"10.1186\/s12902-024-01636-y"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.idc.2020.10.007","article-title":"Skin and Soft Tissue Infections in Patients with Diabetes Mellitus","volume":"35","author":"Polk","year":"2021","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"651","DOI":"10.21614\/chirurgia.113.5.651","article-title":"Soft tissue infections in diabetic patients","volume":"113","author":"Doran","year":"2018","journal-title":"Chirurgia"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Suaya, J.A., Eisenberg, D.F., Fang, C., and Miller, L.G. (2013). Skin and soft tissue infections and associated complications among U.S. patients. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0060057"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1067\/j.cpsurg.2014.06.001","article-title":"Necrotizing soft tissue infections: Review and current concepts in treatment, systems of care, and outcomes","volume":"51","author":"Hakkarainen","year":"2014","journal-title":"Curr. Probl. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2253","DOI":"10.1056\/NEJMra1600673","article-title":"Necrotizing Soft-Tissue Infections","volume":"377","author":"Stevens","year":"2017","journal-title":"N. Engl. J. Med."}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/4\/124\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T08:35:35Z","timestamp":1775032535000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/4\/124"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,31]]},"references-count":20,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["diseases14040124"],"URL":"https:\/\/doi.org\/10.3390\/diseases14040124","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,31]]}}}