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treat with T2DM. His details of neuropathy were unknown; however, he had a lot of risk factors for impaired blood flow including not only diabetes and hemodialysis but also hypertension, dyslipidemia, hyperuricemia and smoking. He had diabetic retinopathy at age 39 and had undergone left vitreous surgery at 40 and right vitreous surgery at 47. When he had myocardial infarction and percutaneous transluminal coronary angioplasty at age 50, he started taking aspirin (100 mg/day). His vital signs were as follows: heart rate 89 beats/min, blood pressure 84/45 mmHg and temperature 36.3 °C. Laboratory data were: white blood cell count, 15940/μL (neutrophil 92.0%); red blood cell count, 425 × 104/μL; hemoglobin, 12.1 g/dL; platelet, 15.0/ μL; C-reactive protein (CRP), 47.69 mg/dl; procalcitonin, 31.9 ng/mL; creatinine, 10.62 mg/dL; blood urea nitrogen, 53 mg/dL; sodium, 129 mmol/L; potassium, 4.4 mmol/L; chloride, 96 mmol/L; plasma glucose, 484 mg/dL; hemoglobin A1c (HbA1c), 9.7%; glycoalbumin 29.2%. Computed tomography (CT) revealed subcutaneous extensive foci of gas throughout his leg from the right tip of the toe region to the knee joint region (Fig. 1a–c). Furthermore, CT angiography revealed severe arterial calcification throughout the whole body (Fig. 1d). Peripheral sensory neuropathy of his remained foot was severe, and he could not feel pain on his foot. His kneecap reflex and Achilles tendon reflex were lost. He could feel vibration on foot for only 2 s. Monofilament test revealed that he could feel the 5.07 (10 g) filament on the beginning part of big toe, but not another site. Nerve conduction study revealed that compound muscle action potential (CMAP) was low and sensory nerve action potential (SNAP) was not detected on his remained foot. These results suggest that he had severe diabetic neuropathy. First, we performed the debridement and intravenous antibiotics therapy (3.0 mg/day of meropenem hydrate). Arcanobacterium haemolytic, group G β-streptococcus, Dear Editor,

Non-clostridial gas gangrene in a patient with poorly controlled type 2 diabetes mellitus on hemodialysis