Kent State University
88 years old female patient came to the ER on 5/22/12 with the chief complaint of erythema, swelling and pain in her lower extremities. According to her, she saw her podiatrist about 2 days prior to this admission and podiatrist advised her to go to the ER. According to her, both legs have always been red, but they got much more discolored and painful, particularly the right leg. She denied any fever or chills, any sputum production or any other symptoms.
Primary Medical diagnoses: Cellulitis Cellulitis is a spreading bacterial infection of the dermis and subcutaneous tissues. It causes local signs of inflammation, such as warmth, erythema, pain, lymphangitis, and frequently systemic upset with fever and raised white blood cell count. Cellulitis is most often caused by group A β-hemolytic streptococci (e.g., Streptococcus pyogenes) or Staphylococcus aureus. Streptococci cause diffuse, rapidly spreading infection because enzymes produced by the organism (streptokinase, DNase, hyaluronidase) break down cellular components that would otherwise contain and localize the inflammation. Staphylococcal cellulitis is typically more localized and usually occurs in open wounds or cutaneous abscesses.
Infection is most common in the lower extremities. Cellulitis is typically unilateral; stasis dermatitis closely mimics cellulitis but is usually bilateral. The major findings are local erythema and tenderness, frequently with lymphangitis and regional lymphadenopathy. The skin is hot, red, and edematous, often with surface appearance resembling the skin of an orange
(peau d'orange). The borders are usually indistinct, except in erysipelas (a type of cellulitis with sharply demarcated margins). Petechiae are common; large areas of ecchymosis are rare. Vesicles and bullae may develop and rupture, occasionally with necrosis of the involved skin. Cellulitis may mimic deep venous thrombosis but can often be differentiated by one or more features. Fever, chills, tachycardia, headache, hypotension, and delirium may precede cutaneous findings by several hours, but many patients do not appear ill. Leukocytosis is common.
➢ The patient has bilateral erythema, edema, and tenderness. There are no vesicles or bulla Patient has stasis dermatitis and venous stasis.
Treatment: Treatment is with antibiotics. For most patients, empiric treatment effective against groups, streptococci and S. aureus is used. Oral therapy is usually adequate with dicloxacillin 250mg or cephalexin 500 mg qid for mild infections. For more serious infections, oxacillin or nafcillin1 g IV q 6 h is given. ➢ Patient was treated with Ancef (cephazolin) 1g q day IV.
Other Medical Diagnoses:
1. Diabetes Mellitus Type 2 Diabetes mellitus (DM) is impaired insulin secretion and variable degrees of peripheral insulin resistance leading to hyperglycemia. In type 2 DM (previously called adult-onset or non–insulin-dependent), insulin secretion is inadequate. Often insulin levels are very high, especially early in the disease, but peripheral insulin resistance and increased hepatic production of glucose make insulin levels inadequate to normalize plasma glucose levels. Insulin production then falls, further exacerbating hyperglycemia. The disease generally develops in adults and becomes more common with age. Plasma glucose levels reach higher levels after eating in older than in younger adults, especially after high carbohydrate loads, and take longer to return to normal, in part because of increased accumulation of visceral and abdominal fat and decreased muscle mass. Hyperglycemia develops when insulin secretion can no longer compensate for insulin resistance. Although insulin resistance is characteristic in people with type 2 DM and those at risk for it, evidence also exists for β-cell dysfunction