c/o fever with chills followed by spontaneous eruptions of multiple cutaneous papule with simultaneous bullae of left lower limb or also had ulcers with erythematosus base and black skin pathches 26 year old female with history just 4 days back .cultures are negative..counts 16000 with 90 neutrophils . with mild RFT deranged . No e/o dvt ...dermatology opinion ...suspecting ecthyma gangrenosum/pyoderma gangrenosum/vasculitis . biopsy report awaited pt started on piptaz and fasciotomy was done no improvements . recently started on inj dexamethasone ...wat could be the diagnosis ...and how to proceed ahead ....



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This is the reference mentioned in my earlier reply. Acute Postoperative Herpes Zoster With a Sciatic Nerve Distribution After Total Joint Arthroplasty of the Ipsilateral Hip and Contralateral Knee Kyung Soon Park, MD, Taek Rim Yoon, MD, Sung Kyu Kim, MD, Hyeoung Won Park, MD, and Eun Kyoo Song, MD Abstract: The differential diagnosis of a patient with acute onset of hip pain during the postoperative recovery period after total hip arthroplasty includes sciatic nerve injury, infection, incisional pain, hardware, or simply muscular issues related to overactivity. Moreover, because the rash of herpes zoster develops after 4 or 5 days of pain, it is difficult to diagnose herpes zoster during the early period. A number of reports have been issued on herpes zoster after surgery or trauma, but no report is available on herpes zoster development with a sciatic nerve distribution after ipsilateral total hip arthroplasty. The authors report the case of 75-year-old woman with herpes zoster with a sciatic nerve distribution after 2 primary total joint arthroplasties of a hip and knee. Keywords: herpes zoster, sciatic nerve distribution, total hip arthroplasty, total knee arthroplasty. � 2010 Elsevier Inc. All rights reserved. Varicella-zoster virus (VZV) belongs to the herpesvirus family and is a double-stranded DNA virus that causes 2 distinct syndromes. The primary infection (chicken pox) presents as a highly contagious rash associated with clusters of vesicles on the skin and mucous membranes. Subsequent reactivation of latent VZV in the dorsal root ganglia or cranial nerves results in dermatomal cutaneous eruptions, herpes zoster, or shingles. The virus is known to remain dormant throughout the affected individual's lifetime, and in this dormant state has an ever-present potential for reactivation, although the mechanism of this is unknown [1]. Herpes zoster secondary to reactivation of a previous VZV infection has been reported to occur within surgical wounds and after trauma [2,3] and has also been described after breast reconstruction, breast radiotherapy [4,5], dental procedures or facial surgery [6], liver biopsy [7], thoracic sympathectomy [8], and after spinal surgery [9,10]. In this article, we report the case of a 75-year-old female who had herpes zoster with a sciatic nerve distribution after sequential total joint arthroplasty on an ipsilateral hip and a contralateral knee. We believe this is the first case report of varicella zoster reactivation with a sciatic nerve distribution after joint arthroplasty. Case Report A 75-year-old woman visited our hospital with com�plaints of left hip and right knee pain for duration of 3 months and 4 years, respectively (Fig. 1). She complained of more pain in left hip, and physical examinations showed a left hip range of motion of 110� of flexion, 15� of extension lag, 45� of external rotation, 20� of internal rotation, 20� of abduction, 10� of adduction, and a positive result in Patrick test. Joint space narrowing and subchondral sclerosis of left hip in simple radiographs suggested left hip osteoarthritis. Cementless total hip arthroplasty (THA) was performed under general anesthesia (Fig. 2). Walker ambulation was allowed 2 days post-THA, and gradually her exercise capacity and pain improved. Ten days post-THA, she underwent total knee arthroplasty (TKA) under general anesthesia. Preopera�tively, a physical examination

It is herpes zoster in sciatic nerve distribution. Such cases are discribed after hip replacement . Reactivation due to any cause can make HZ appear. Necrotising faciitus a favourite diagnosis seen often on Curofy is disproved conclusively in this case atlest in drawing blank on faciotomy , as admitted. Septicaemia is also overdiagnosed often without necessary evidence.. as in this case. Sorry for contradicting the stalwarts. The contradiction is evidence based, not personal. The reference of HZ in sciatic distribution will be provide if asked. Hope this helps to solve the iotrogenic riddle, if u permit me to say....

Clinical impression: Bullous Impetigo causing necrotizing fasciitis and septicemia [Reports suggest that nonsteroidal antiinflammatory drugs (NSAIDs) increase the risk of developing Group A streptococcal (GAS) necrotizing fasciitis]. Management suggested: Continue antibiotic. Change if culture helps. Avoid steroidal as well as nonsteroidal anti-inflammatory drugs as far as possible. 1.    Repeat blood and discharge culture. 2.    HIV status and blood sugar 3.    Follow up with •    WBC count •    ESR •    CRP (LS)

The whole lesion is along long saphenous vein track. Urgent doplar study of limb vasculsrity. ??Thrombosis pjebitis . Review with report ??Dm

Venous Doppler normal

Cellulitis Kindly Stop inj dexa... it will further worsen it Go for injectable linezolid Topical antibiotic Oral analgesics

Mam actually it was advised by dermatologist itself

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Necrotising fasciitis

Norcosting facilitis.Needs urgent Fasciotomy.

Not plastic surgery problem

Bullous impetigo dd fascitis necrosis

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