54 yo lady was admitted to the infectious diseases hospital within 2 weeks from the onset of the disease with complaints of febrile fever, and ulcerative skin defects of the trunk (subclavian and axillary region - one element on both sides (up to 2 cm in diameter), one defect below the navel (1.5 cm) and the largest defect (up to 3 cm) on the skin of the lower medial segment of the right breast). Also patients noted moderate edema and redness in the area of the metatarsophalangeal joint of the left foot. Skin defects represented a fairly deep ulcer elements with abundant purulent discharge, pus easy run from ulcers when lightly pressed, and the defects were not caused a sharp pain sensations or itching. The patient suffers from overweight, diabetes mellitus (inpatient glycemia level 8-10 mmol/l solely on the diet). She didnt have such ulcers before. From the anamnesis it is known that in the last 4 years she unsuccessfully treated chronic recurrent iridocyclitis with ophtalmologiust, however, in the present hospitalization oshe didnt have any eye problem. Epidemilogocal and travel anamnesis without features. The patient was conscious, oriented correctly, criticism saved, despite pronounced fever and the presence of multiple purulent ulcers general toxic syndrome almost absent - saved appetite, there is no evident weakness, headache. Started antibiotic therapy Ceftriaxone 2 gr IV + metronidazole IV + local treatment (daily ulcer cleaning with antiseptic). Despite tese efforts fever persisted. Some ulcer cleared from pus, however, there has been a sharp increase in the diameter of ulcerative defect on the chest. Antibiotic were exchanged for IV levofloxacin + doxycycline per os – without positive effect. What is your diagnosis? I intentinally didnt write about one very inmportant camplain of this lady because telling it to you would made a case redicolously easy one. Sorry for that but may be you will guess what I have missed in her complains.
Posted on: Tue, 06 Jan 2015 19:48:23 +0000
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