Concluded Case

6 yr old female presenting with non heaing ulcer for last 2 yrs. Now has developed into cellulitis involving almost half of right foot. She walks bare foot all the time. Kindly suggest diagnosis and management. RBS 126 mg/dl TLC - 53,000/cumm Platelet - 4.94 Lakh/cumm RFT - WNL Hb - 11.5 g%

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Get her fasting blood sugar tested to rule out T1 DM - as a random BS of 126 is equivocal Considering her TLC of 53000 / cu mm - she may progress to fulminant septicaemia . Start aggressive treatment with Parenteral antibiotics Inj cefoperazone 500 mg + sulbactum 250 mg B.D and Amikacin 150 mg B.D for 1 week Appropriate debridement in O.T setting. As non- healing ulcer is for 2 years get a colour doppler study of lower limb vessels to look for vascular insufficiency- if any .

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Non healing ulcer with cellulitis Xray to r/0 osteomyelitis Ct angiogram WBC 53000 doubts of malignancy Mri & opinion of haematologist

Get her fasting blood sugar tested to rule out T1 DM - as a random BS of 126 is equivocal Considering her TLC of 53000 / cu mm - she may progress to fulminant septicaemia . Start aggressive treatment with Parenteral antibiotics Inj cefoperazone 500 mg + sulbactum 250 mg B.D and Amikacin 150 mg B.D for 1 week Appropriate debridement in O.T setting. As non- healing ulcer is for 2 years get a colour doppler study of lower limb vessels to look for vascular insufficiency- if any .

Send PBS for abnormal WBCs Hygeine is very important in this case along above measures!!!

Type 1 Diabetes with trophic ulcer, and cellulitis Suggest Diabetic work up, serum C peptide, arterial color doppler of foot, check for loss of sensation,xray foot to rule out osteomyelitis of foot bones . If found to be diabetic, IV insulin, antibiotics, debridement, dressings

Soft tissue injury followed by secondary bacterial infection with cellulitis. Rx 1. Oral Co Amoxyclav x 7 dats 2. Local dressing of the ulcer and keep it protected from being unclean..

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!

Ruleout infective etiology. Must consider leukaemia for chronic ulceration...

None healed Ulcer Try quick heal cream from sri sri ayurveda with internal medicine

Ulcer with cellulitis

Trophic nonhealing ulcer with cellulitis First take xray foot and r/o underlying bone disease It needs proper debridement up to depth and drainage of pockets I don't think there should be any problem in healing likely proper treatment has not been provided Broadspectrum antibiotics Antiinflamatory Immobilization of foot

Thankyou so much sir.
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