9m male child presented with c/o rt thigh osteomyelitis from last one month following a episode of trauma on rt thigh. Incision and drainage was done child improved for two days after that child developed severe distress with bluish discolouration of finger tips and echo was done showed vegetation over posterior mitral leaflet and aortic valve thus child was shifted I.E management. currently from last 5 days child developed this lesion due to nasal prongs before the child brought to us.. spot diagnosis ? culture awaited

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9 months with right thigh OSTEOMYELITIS. 2D ECHO VEGETATIONS ON POSTERIOR MITRAL LEAFLET & AORTIC VALVE. NASAL PRONG INJURY. BLOOD C/S. I.V. ANTIBIOTICS AD PER CULTURE SENSITIVITY PATTERN, TILL DUCH TIME THE ANTIBIOTICS CHOICE IS : I.V. VANCOMYCIN PLUS CEFTRIAXONOE. ORBITAL CELLULITIS PRESENT. MRI BRAIN TO R/O THROMBOSIS. IF THROMBO-EMBOLISM RISK ONE SHOULD START HEPARIN TO PREVENT STROKE. D-DIMER ESTIMATION. CO-GULATION PROFILE. DX : SEVERE SEPTICEMIA, WITH BACTERIAL ENDOCARDITIS DUE TO STREPTOCOCCUS PNEUMONIA.

Presentation is like disseminated staphylococcal infection.... Pseudomonas islated from blood or wound?? Pseudomonal infection is probably super added infection other wise you must look for the predisposing factor for pseudomonal infection

Ear pus cs and wound cs showed pseudomonas
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THIS 9 MONTH NEONATE HAS GOT MULTIPLE CONG ANAMOLIES 1 BLEPHROPHYMOSIS SYNDROME NASAL PATHOLOGY THEIR IS AN OVAL HORIZONTAL FLAP LIKE SWELLING ARISING FROM MIDDLE OF NOSENAND BELOW UNLIP MARGIN

It's a case of iatrogenic gangrene of nostrils with cellulitis with bacterial endocarditis with septicaemia. Difficult to treat require antibiotic sensitive to pseudomonaze and gram positive organism. Opinion of plastic surgeon and ped surgeon will be helpful.

Septiv gangrene due to vascular septic thrombosis . Vascular opinion urgent drainage to reduce oedema.. effrctive controll of sepsis . Pesdiatriccians . Plastic sirgepns

Hemangioma with ulceration.

Sir it's ecythma gangrenous caused by psuedomonas infection. Culture just came back
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It is a case of Cellulitis of face & gangreenRx. Appropriate antibiotic and Slough Excision under General

Vasculitis leading to ischemic necrosis of skin and soft tissue.

I agree with Dr B Merugu

Danger area

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