Scrotal Edema as a Rare Manifestation of Diabetic Ketoacidosis in the Setting of Hypoalbuminemia: A Case Report

We present the case of a 64-year-old male with a history of type 2 diabetes mellitus and bilateral lower limb neuropathy who initially presented with fever, leukocytosis, and right lower leg cellulitis. Imaging revealed a retained diabetic needle with a surrounding abscess that was treated with debridement. Wound debridement cultures grew methicillin-resistant Staphylococcus aureus, and he was discharged on a course of oral linezolid. Three days following discharge, the patient was readmitted with hypotension, prerenal acute kidney injury (AKI), hypoalbuminemia, and hyperglycemia due to insulin nonadherence. Venous blood gas confirmed diabetic ketoacidosis (DKA). During hospitalization, the patient developed painless scrotal edema. The scrotal edema was treated with intravenous albumin and oral bumetanide. This edema was likely caused by generalized hypoalbuminemia from aggressive fluid resuscitation and insulin treatment, in conjunction with prerenal AKI. This case highlights scrotal edema as a rare sequela of DKA that should be considered after urgent causes are ruled out, especially in cases of chronic disease nonadherence and large-volume fluid therapy.