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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 . leukamoid reaction . she is too young to suspect diabetes . though it can b there . here random blood sugar within normal limit. send swab c/s . h/o contact with tuberculosis n investigate for the safe . immunodeficiency can b considered here too . add the patient n start inj vancomycin and inj cefotaxime . proper dressing of the wound .

Cellulitis. If HBA1C value is trust worthy, obviously it's due to uncontrolled diabetics. But in view of age of patient i thing repeat GTT should be performed with HBA1C. If non diabetic than its due to inadequate antibiotic coverage, in doses and in duration.. Rule out any bony involvement thru X Ray. Till than deep debridement and drainage . Pus C.& .S anfd follow accordingly. If necessary consult vascular surgeon.

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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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 .

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

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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

Ulcer with cellulitis due to vanous insufficiency with sepsis Do x-ray to rule out bone deformity Rule out Diabetes Start Antibiotics Antiinflammatory Appropriate debridement Dressing Immobilisation of foot

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..

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

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