May 30 2009, 08:19 AM
QUOTE(CyberSetan @ May 23 2009, 04:07 PM)
To all doctors and medical students here, do a preliminary diagnosis on this:
- Explain your diagnosis.
Here is another clue, i wont spoil the diagnosis yet, the picture below is taken before the pictures above, what can you see?
Alright, it has been a week already. Spot diagnosis time over, Time to give the patient's history:» Click to show Spoiler - click again to hide... «
» Click to show Spoiler - click again to hide... «
» Click to show Spoiler - click again to hide... «
- Explain your diagnosis.
Here is another clue, i wont spoil the diagnosis yet, the picture below is taken before the pictures above, what can you see?
» Click to show Spoiler - click again to hide... «
The patient was a 63 years old Indian farmer.
Presented at the hospital's emergency department with complaint of severe pain and difficulty walking, there is an extensive cellulitis extending from the distal and medial aspect of the right leg up to the proximal posterior aspect, involving the areas around the medial malleolus and the calf.
Several fluid/puss-filled bullae are also present on the affected area of which some has burst forming exudating cavities. The patient however does not present with fever, shock or any signs or symptoms indicating the presence of septicemia.
The patient previously had a deep puncture wound caused by a stick near his right heel while farming 1 week before. The wound was neglected by the patient which subsequently became infected and inflamed to the previously mentioned state. Patient only sought treatment when the pain and difficulty walking has become unbearable.
The patient is non-diabetic and non-hypertensive. The patient did not seek any medical treatment prior to the presentation in the emergency department and had instead consulted an ayurvedic practioner for treatment.
The patient had refused admission and undergone drainage of puss and debridement of the necrotic tissues, cleaning and dressing of the affected limb, administered broad spectrum antibiotic pending the result of C&S and was told to return for a follow-up 2 days later.
The patient however disregarded the advice given and only returned 1 week later due to the worsening of the condition (as seen in the pictures above).
The dressing was evidently not changed and was soaked with exudative fluid/puss (note the greenish discoloration). Upon removal of the dressing, the limb also showed greenish discoloration (see pictures) at some areas along with a distinct necrotic smell. The physician on duty concluded that there might be an added pseudomonas infection present and have sent another sample for C&S.
Debridement was done again and this time the patient was admitted and treated for streptococcal and pseudomonas infection. Due to the extensive damage, skin graft from the patient's left thigh was taken and grafted on the affected limb. The patient was discharged after a few days of observation.
(i might add more pictures from other cases later)
what else to do? hmm
Quote
makes me hate the :extremists" more
Seriously, I have a great interest in Medical field and I will pursue my dream in Medicine (MBBS) . 
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