A 76yr old female with known history of Diabetes mellitus on medications and treated for CLL with Chlorambucil 2mg, presented with intermittent Fever (102°F) since one week with skin lesions near the Vulva and towards the anal skin as shown in the image. She is in severe pain during leg movements, no burning pain during micturition, no foul smelling discharge. She also has multiple oral lesions as shown. What's the likely diagnosis? What's the further management.

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Genetial Candidiasis. Vulvar allergic contact dermatitis... However, is not uncommon and can be associated with the use of topical anesthestic compounds such as benzocaine. Our patient's history is consistent with allergic contact dermatitis secondary to topical benzocaine use... Diabetes must be well controlled.. Antifungal topically...Broad-spectrum antibiotic. Ketaconazole shampoo wash.

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? Vulver Eczema Herpeticum With ? Oral Candidiasis

Fungal infection Antibiotics Oiments Antiallergic Analgesic

IT'S T2DM CASE.. PLEASE CHECK O/E IN VITALS?? ( SPO2 , HR , TEMP, BLOOD PRESSURE ). DUE TO UNCONTROLLABLE DIABETES ? I THINK C- REACTIVE PROTEIN WAS INCREASE ?? SGPT AND SGOT ALSO INCREASE?? ORAL ULCERATION? CLEAN WITH HYDROGEN PEROXIDE.. AND ANTISEPTIC APPLY ON THESE ANAL REGION ... IT'S MY OPINION REFER TO DIABETOLOGIST / ENDOCRINOLOGIST??

Tight glycemic control Antibiotics Optimum Antifungal therapy.

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Fungal infection due to low immunity: - CBC,ESR,CRP, Lab test of lesion scrapings to detect fungus Anti fungal tt To maintain hygiene

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Diebetic mellitus..? Management.. However, metformin remains the recommended first-line drug. It not only lowers blood sugar, Pantalone said, but also carries a low risk of hypoglycemia (potentially dangerous drops in blood sugar). Metformin (Fortamet, Glumetza, others) is generally the first medication prescribed for type 2 diabetes. It works primarily by lowering glucose production in the liver and improving your body's sensitivity to insulin so that your body uses insulin more effectively. Most diabetic patients are found to have oral manifestations, e.g., periodontal disease, xerostomia, burning mouth, salivary gland dysfunction, geographic tongue, candidiasis, etc. Buccal alterations could also be easily observed in patients with DM, especially coated tongue... Proper maintenance hygiene.. Excercise.. Control blood sugar... Meditation... Fruit is also an important source of vitamins, minerals, and fiber. However, fruit can also be high in sugar. People with diabetes must keep a watchful eye on their sugar intake to avoid blood sugar spikes. ... Fruits high in carbohydrates. Food Carb content 1 serving of dried fruit ..

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Fungal infection Hamycin lotion locally Tab Candid 200 mg od TBact oint locally Nsaid orally Tab Levocet bd

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It's all d/t immunocompromised condition as a result of chemotherapy,kindly adv tb fluconazole 150 mg OD Tb doxy 100 mg bd Tb Azithromycin 500 mg OD For 5 days Apply candid mouth wash for oral ulcers,give b complex supplements

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Likely to be febrile neutropenia with fungal infection (Candida infection) She needs admission, isolation, investigation complete blood count, blood culture, liver function test, renal function test She needs treatment with Inj. Capsofungin 70 mg once a day followed by 50 mg once a day

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