A 33-year-old woman presented to the emergency department because of “pain and swelling in upper extremity” with no history of trauma and fever. She was a known case of diabetes mellitus for 12 years who was under insulin therapy. She had separated from her husband and was living alone. On physical examination, she was afebrile with no abnormality in general examination but had multiple local erythema on her left upper extremity skin with tenderness and crepitation. There were small red macules and papules over sites of erythema which were crusted in some areas. Her left hand x-ray (Figure 1) was significant for subcutaneous emphysema. All laboratory studies were within normal limits. On further questioning, she had multiple admissions during the previous year with the same complaint and all the diagnostic workups were inconsequential.