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Paper text:
eikenella corrodens is a slow growing , nonmotile , 
 facultative anaerobic , gram - negative bacillus which is commensal 
 of the oral cavity , intestinal and genital tracts [ 13 ] . 

the most common clinical sources of this organism are human bite 
 wounds , head and neck infections and respiratory tract infections 
 [ 1 , 2 , 4 ] .
eikenella species have also been shown to cause 
 endocarditis , intraabdominal infection , pancreatic abscess , 
 arthritis , vertebral osteomyelitis , discitis , orbital cellulites , 
 thyroid abscess , brain abscess , liver abscess and genitourinary 
 infections [ 13 , 58 ] . according to   our research ,
this 
 is the first report of eikenella corrodens causing vulvar 
 abscess in a diabetic patient in english literature .
a diabetic 55 year old woman was admitted to zonguldak karaelmas 
 university emergency clinic with a complain of an insidious onset 
 of swelling in the left part of vulva , a pain radiating to the 
 left inguinal region , chills and high fever over a week .
she has 
 had hypertension and type ii diabetes mellitus and has used oral 
 anti - diabetic and anti - hypertension drugs for 8 years .
she had no 
 history of previous trauma , operation , underlying skin lesion , use 
 of foreign body or human bite on her vulvar region .
two days after 
 onset , her left part of the vulva became swelling and the lesions 
 color turned to red . even though she had used 
 amoxicilline - clavulanic acid and ornidasole for three days , the 
 lesion on the vulva and pain worsened .
in clinical examination her fever 38c , 
 pulse 96/dk , blood pressure 160/80 mmhg , in the left part 
 of the vulva there was an erode lesion in the certain part of the 
 inflammatory halo .
the lesion was 5  4 cm in size , red , 
 hot , swollen , and painful and fluctuant .
laboratory values were as follows : wbc count , 18200/ mm 
 ( 82% neutrophils , 8% lymphocyte , 8% monocytes ) 
 [ 400010000/mm ] ; erythrocyte sedimentation rate ( esr ) , 122 mm / hour [ 020 mm / hour ] ; 
 c - reactive protein , ( + + + + ) [ negatif ] ; and blood glucose , 
 235 mg / dl [ 70110 mg / dl ] .
vulvar abscess was diagnosed and it was drained . in gram stain of 
 the pus , granulocytes ( 80% neutrophil ) ,
ampicilline - sulbactam 
 4  1 gr iv / day , ciprofloxacin 2  400 mg 
 iv / day and local care with 2% eau borique fluid were started 
 empirically .
following drainage , her fever , 
 leucocyt count became normal and , edema , pain and erythema of the 
 lesion subsided .
eikenella corrodens and metisilline sensitive staphylococcus epidermidis ( msse ) were isolated from culture of the pus .
after 3 days of the treatment her fever , 
 white blood cell count was normal , esr was 100 mm / hour .
the 
 patient completed 14 days of treatment with resolution of signs 
 and symptoms .
the esr was 72 mm / hour in the first week of 
 the treatment , 30 mm / hour at the end of the treatment .
an 
 informed consent was obtained from the patient to use of her 
 photographs .
a break in barriers , 
 such as mucous membranes or the skin , can lead to hematogenous 
 spread and serious eikenella infections .
it is 
 described that previous or concomitant illness had a greater 
 association with eikenella infections than did a 
 previously healthy status .
diabetes mellitus is one of these 
 underlying conditions ; our case is also type ii diabetic patient .
eikenella is typically susceptible to many antibiotics , 
 including penicillin g , ceftriaxone , amoxicillin - clavulonic acid , 
 and fluoroquinolones .
some of 
 the -laktamases 
 produced by eikenella are inhibited by clavulonate and 
 sulbactam , however -laktamase production is uncommon at 
 present
. surgical drainage may be more important than 
 antibiotics alone in the management of eikenella 
 infections .
our patient was started on 
 amoxicillin - clavulonate and ornidasole before admitting to our 
 hospital and not responded well until drainage of the abscess . 

depending on the location of infection , treatment choice is a 
 combination of surgical management and antibiotics .
our patient 
 has been successfully treated with ampicilline - sulbactam and 
 ciprofloxacin for 14 days .
there are a few literatures reporting that esr is a valuable test 
 in genital abscess [ 9 , 10 ] .
however , we could not find any 
 study showing correlation between esr level and vulvar abscess .
on 
 the other hand , in a study reported by paul and patel including 
 54 children and adolescents with e. corrodens 
 infections elevated esr was detected for most of the patients and 
 the authors considered that esr was a better indicator than wbc 
 count for e. corrodens infections . in this case , esr was 122 mm / hour at the onset of the illness and esr level reduced to 30 mm / hour at the end of the treatment .
e. corrodens causes various clinical manifestations 
 especially in diabetic patients and esr may be a good indicator of 
 eikenella corrodens infections .
we report a case of eikenella corrodens causing vulvar abscess in a diabetic patient . 
 eikenella corrodens is a slow growing , nonmotile , facultative anaerobic , gram - negative bacillus which is commensal of the oral cavity , intestinal and genital tracts . 
 the most common clinical sources of this organism are human bite wounds , head and neck infections and respiratory tract infections . in our knowledge , 
 the presented case is the first report of eikenella corrodens causing vulvar abscess in a diabetic patient .