Concluded Case

65 year old male presented with multiple tiny punched out ulcers since 3 months. Post Transcutaneous electrical nerve stimulation therapy for Diabetic peripheral neuropathy with cellulitis over left lower limb which is associated with pain redness and increased peripheral warmth. His sugars and BP are under control. Any advices my dear respected colleagues

(Edited)

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Concluded answer

Ischaemic ulcers precipitated by trivial injury during transcutaneous electrical nerve stimulation. Presentation of punched out ulcers with pale base is typical of ischaemic ulcers . Get a colour doppler study of lower limb vessels to look for vascular insufficiency. Add tab cilostazol 100 mg B.D for 2 months to improve blood supply to limbs. Do local dressings with betadine lotion cleaning and mupirocin ointment after adequate debridement

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The ulcers appears to be Punched out Circular margin& even Base appears anemic ( not erythematous) Hence these are Arterial ulcers - Diabetes is a risk factor for arterial ulcers Inv- Arterial Doppler Arteriography Ankle Brachial index Search for other risk factors - Smoking Hypertension Obesity Renal failure - Amputation is a dreaded complication

Thank you doctor
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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!

Thanks
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PYODERMA GANGRENOSUM ECTHEMA GANGRENOSUM. CELLULITIS ADVISABLE.... COLOR. DOPPLER BLOOD AND. URINE. CULTURE. /. SENSITIVITY

Pyoderma gangrenosum ?post traumatic ? ecthyma

I agree
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@advice color doppler.

Pyoderma gangrenosum / Ecthyma Gangrenosum? ?

Gumma syphilitic, Benzathine Penicillin 24 lakhs weekly IM 3 weeks. Or Erythromycin 2 gm a day or azithro 500 mg a day 3 weeks

Sir, i dont think its an syphilis
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IT'S A CASE OF.. * PYODERMA GANGRENOSM.. * ECTHYMA GANGRENOSM. * POST TRAUMATIC ULCERS (ELECTRIC).. WITH CELLULITIS.. NEED'S..HISTOPATHOLOGICAL EVALUATION.. HEMOGRAM.. URINE ROUTINE BSR HBA1C.. PUS C AND S EXAM.. TREATMENT AS PER CAUSES.. BROAD SPECTRUM ANTIBIOTICS WITH NSAID.. MULTIVITAMINS ANTIOXIDANTS.. TOPICALLY..MUPIROCIN.. EXPERTS OPINION ..

Tnx a lot Dr Mansukh Shah
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Electric burn injuries with gangrenous skin

Electric burn injuries with gangrenous skin.
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Color doppler suggested for any deep vein pathology HbA1c

I agree
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