A 75 year old man presented to the OPD with pain swelling and blisters on the ankle and leg on left side.


June 05, 2023

Hello everyone. I am Nikhil, a third proffesional MBBS students at kamineni. 


This is an online E logbook to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through a series of inputs from the available global online community of experts intending to solve those patients' clinical problems with collective current best evidence-based inputs


CHIEF COMPLAINTS


A 75 year old man who is a farmer by occupation from Villamla presented to the OPD with complaints of pain and edema in the right ankle and foot which gradually progresses upward towards the groin. He also complaints of immobility in the foot. 


HISTORY OF PRESENTING illness


The patient developed the same situation 2 years back when a thorn pricked him on the medial side of his left leg and led to an infection.on visiting a local RMP, he was put on medication and the site was properly cleaned with warm water. He went back to normal after that. 

the patient was apparently asymptomatic 1 week back. Then he observed unilateral swelling in his right ankle and foot. Gradually it progressed to his leg and then to his thigh.the patient describes the pain to be a burning type of pain. He had taken no medication for the pain. However, he applied jhandu balm on the site which led to formation of blisters according to the patient. After being sdmitted in kims hospital, he had burning micturition and black urine which subsided on medication


History of past illness

No diabetes

No hypertension

No thyroid

No asthma

No cad

No epilepsy

No surgical history

No blood transfusions

Patient randomly takes pain medication on limb pains


PERSONAL HISTORY


married

Mixed diet

Works as a farmer

Normal bowel

Normal bladder

Alcohol addiction 

Quit 15 days ago

Smoker

No other addiction


General examination



Patient is conscious, coherent and cooperative

Well versed with time space and people around

No palor

No icterus

Clubbing of fingers present

No lymphadenopathy

No central cyanosis

No peripheral cyanosis

No erythema

Unilateral swelling and blister on right foot radiating to leg and thigh gradually to groin

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Treatment protocol


Normal diet

Inj. Monocef iv BD

Inj. Metrogyl iv TID

Inj pan 40 BD

Tab limcee

Tab dolo 650 


Foot end elevation

DAY 2 MY OBSERVATIONS

PATIENT SAYS BURNING PAIN HAS REDUCED. 

HOWEVER, HIS SKIN SEEMS TO BE PEELING OFF. BANDAGE REMOVED FOR CLEANING AND REBANDAGING DONE. 

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