30D/ M Wt-3.6kg C/O - Swelling and redness over lower abdomen, penis , scrotum and medial aspect of both thighs since 3 days H/O fever present O/E- GC- Below avg/afebrile P- 112/min SPO2- 98%on O2 CNS- active cry + CVS- S1S2+ Resp- B/L air entry +nt P/A- soft LE-redness over lower abdomen, penis , scrotum and medial aspect of both thighs. Raised temperature over the skin Pus flakes present over the penis and scrotum IMP - Cellulitis of lower abdomen, penis, scrotum and thigh. Attachments Clinical pic Usg swelling Usg b/l inguinoscrotal region CBC

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good case doctor . usg wasnt needed . as the diagnosis is very clear . seeing the photograph . theres no time to waste . give good cover for staphylococcus aureus . n send blood c/s . start the patient on inj vancomycin n inj piperacillin tazobactum . avoid cephalosporins most of these cases are resistant to them these days . my d/d s staphylococcal scalded skin syndrome / necrotising fascitis .

Thanks sir.

It is a case of Fournier' s gangrene or necrotising fasciatis of scrotum and penis with spreading cellulitis to lower abdominal wall perineum and thighs. It is a very serious condition may lead to septicaemic shock any so needs ICU care IV drip to continue Antibiotic inj Ceftriaxone 250 mg with Salbactum 125 mg iv bd Supportive therapy Management of wound Extensive debribement of scrotal skin and the necrotic material and thus testes may be open and may implanted to pouch made in upper part of thighs Excision of penile affected skin if necessary Regular dreesing Culture sensitivity of would for proper antibiotics Care to be taken for kidney function and vitals.

Thanks Dr Bipin Bihari Jain

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Acute cellulitis with sepsis Leucocytosis Inj piperacillin+inj tazobactum Or meropanum Locally cold sponging Mupirocin oint Antiinflamatory suspension

Thanx dr Vipin Bihari Jain


Tnx Dr Vipin Bihari Jain sir

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Antibiotics cefotaxim 125mg +Amikacin 50 mg tds injection Ointment neosporin locally

Thank you doctor

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Cellulitis 1)wash wound with trifala churna fant 2)then apply AMPUCARE as suggested by Dr Nitin chaube 3)apply combination of shodan tail and ropan tail at a time. abhyantar .... gandhak rasayan 2-0-2 arogyavardhini 2-0-2 wound will heal within 2 months

Thank you sir.