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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

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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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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

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

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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Pyoderma gangrenosum ?post traumatic ? ecthyma

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Pyoderma gangrenosum

Clinical provisional diagnosis: Burns caused by the TENS got worsened due to secondary infection and arteriolosclerosis Transcutaneous electrical nerve stimulation (TENS) is widely used in the management of chronic pain. However, electrical current that is too intense or that is used incorrectly can burn or irritate the skin. TENS due to improper dose selection may progress on to develop severe high grade burns. Worth reading following paper: Burns secondary to improper usage of transcutaneous electrical nerve stimulation:  A case report Mrinalini Sharma et al. P b Journal of Orthopaedics Vol-XII, No.1, 2011

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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!

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Pyoderma gangrenosum. Color doppler is advisable. Proper antiseptic care of wound with muprocin ointment application. Systemic antibiotic. HbA1c Insulin to be started

Thanks ! Dr.Dinesh Gupta
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Color doppler suggested for any deep vein pathology HbA1c

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