Concluded Case

This is old lady 60 plus ,known diabetics on Insulin therapy twice a day .She came to me high fever toxic ,semiconscious ,right leg oedematous pus pointing on the entire skin with hyperpigmented skin.Leg swelling was there for many more years. Taking insulin for over 5 years. Second photograph after treatment of one month. Swelling has come down. pt is not regular in treatment due to poor socioeconomic reason. Discuss the case.

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Concluded answer

Since pt is diabetic and having swelling legs for many years New development was high fever toxic and discharging pus So obviously septicemia was responsible for her condition hence to treat sepsis in view of diabetic control should have been approach anyway you have done right as seen from second picture. Now d/d 1 long standing swelling in diabetic must be evaluated for DVT 2 second thing is sepsis with seeing skin it is PYODERMA

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I do agree with dr sanjoy sarkar. It is filariasis with lymphangitis with septicemia with pyoderma in a uncontrolled DM patient.

Thanks dr partha sir.. Dr nikita
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Filariasis Glycemic control Stasis eczema. Do Investigation like MRI/HEMATOLOGICAL INVESTIGATIONS SOS LOCAL lesion biopsy Surgeon opinion needed See the nerve and VASCULAR supply to the area if sufficient, or it may develop gangrene. The case can b palliative but not completely curable! As per my opinion

Pulse therapy of DEC 100 mg tid for 10 days in a month ,preceded by 21 days course of DEC will keep the filarial worm under checks .The disease may not exacerbated. Whenever the skin infection flare up treat it and primary care is the most Important one. Otherwise diabetes and sepsis may kill her. Management is the need of the diasrase
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*Pyoderma with sepsis due to uncontrolled DM * DVT Control DM by medicine and diet control. Inj ceftum 1gm iv bd. PCM ibu TDS. Multivitamins and antioxidants orally. Clean area with diluted betadine lotion apply saline throughly and gently apply betadine oint locally bd. Improve general health and personal hygiene. Maintain nutrition hydration and hygiene. Keep area clean and covered with sterile gauge. Levocet 5mg SOS if itching present. Raised affected part. Regular monitoring and periodical evaluation required.

Thanks Dr Chhotu Lal dadhich
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Elephantiasis with Pyoderma with Sepsis in a case uncontrolled DM Control DM Inj Meropenem 1gm IV tds Tab Diethylcarbamazapine 100mg tds×4weeks Tab Albendazole + Ivermectin (400+12mg) stat & rept after 2weeks Wash wound with NS Betadine Soln Mupirocin ointment topically Antioxidant R/0 DVT

Thanks Dr Ashok Leel
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Septicemia. Good improvment. Dr

Since pt is diabetic and having swelling legs for many years New development was high fever toxic and discharging pus So obviously septicemia was responsible for her condition hence to treat sepsis in view of diabetic control should have been approach anyway you have done right as seen from second picture. Now d/d 1 long standing swelling in diabetic must be evaluated for DVT 2 second thing is sepsis with seeing skin it is PYODERMA

Thanx dr Manuprsad Dayaram Acharya
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R/o leg elephantiasis....?

Filariasis (lymphatic Elephantiasis)

DD Filarial infection, lymphangitis, with skin changes due to ch lymph obstruction, uncontrolled sepsis , made worse by poor control of DM Another possibility is LSC with severe Eczematous changes Good management, good response Recurrences are possible

Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

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