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Abstract: A 70-year-old Ms. Feng sought medical attention for the presence of a history of tinea pedis for many years. She reported that her right lower extremity presented with symptoms of redness, pain, and fever, which were combined with routine blood tests suggesting a bacterial infection and considered to be a manifestation of dermatitis. The cause of dermatophytosis is mostly caused by Streptococcus b haemolyticus infection, which was considered to be triggered by tinea pedis. The patient was treated with appropriate medication and her condition was better controlled.
Basic information】Female, 70 years old
Disease Type】Dangiosis
Hospital】Ruijin Hospital, Shanghai Jiaotong University School of Medicine
Date of consultation】November 2020
Treatment plan】Medication (sodium penicillin for injection, miconazole nitrate cream, potassium permanganate solution)
Treatment Period】7 days of hospitalization, follow-up in 2 weeks
Effectiveness】Redness and swelling of the right lower limb disappeared, and the disease was basically controlled.
I. Initial interview
When we first saw the patient, we could observe that he was limping and his face was in pain. He reported that he had symptoms of redness and pain in the right lower limb 9 days ago, followed by a high fever, with a temperature of 39℃ and symptoms of chilliness and poor appetite, which was not relieved by self-administration of antipyretic drugs. Physical examination of the patient revealed skin erythema and elevated skin temperature in the lower third of the right lower extremity, enlarged inguinal lymph nodes, and relatively thick right lower extremity, as well as symptoms of molting and erosion in the toe seam. For specific diagnosis, the patient was admitted to the hospital for further examination.
II. Treatment history
After admission, the patient was given routine blood tests, which showed abnormal results of white blood cell count, neutrophils and C-reactive protein, suggesting the presence of bacterial infection. The patient was first given injectable penicillin sodium for 7 days to control the infection in the body, while potassium permanganate solution was given to clean the feet and miconazole nitrate cream to treat tinea pedis to promote symptom relief. On the third day of hospitalization, the patient’s body temperature gradually returned to normal and the routine blood tests were normal. On the seventh day of hospitalization, the disease was basically controlled, and the patient was discharged from the hospital, and continued to receive medication for tinea pedis after discharge.
III. Treatment effect
On the day of admission, the patient was given intravenous infusion of sodium penicillin for injection, together with potassium permanganate solution for foot cleaning and miconazole nitrate cream for foot treatment. On the second day of admission, the body temperature decreased and the appetite improved. On the third day of admission, the body temperature returned to normal and the symptoms of redness and pain in the right lower limb gradually decreased. On the 7th day of admission, the redness and swelling of the right lower extremity disappeared completely, and the routine blood test results were normal, suggesting a good treatment effect.
IV. Precautions
The patient was more cooperative with the treatment and therefore recovered quickly, and I was happy for the patient, but the following matters still need to be noted.
1. Since tinea capitis may be caused by tinea pedis, it is still necessary to actively treat tinea pedis after discharge from the hospital to avoid recurrence of the disease.
2. The broken skin area needs to be actively treated with disinfection to avoid wound infection. In case of skin redness, swelling and fever, avoid blindly using medication to avoid other adverse reactions to the wrong medication.
3. After discharge from the hospital, it is recommended to try to rest in bed and elevate the affected limb, which can effectively promote reflux.
V. Personal insight
Dermatophytosis is an acute infectious disease that occurs mostly in older women, as in the case of this patient, and may be induced due to tinea pedis. Therefore, patients need to actively treat tinea pedis to avoid inducing other diseases. In addition, it is not recommended that the patient in this case take medication on her own when she has pain and fever in her lower extremities, and this may delay her condition because the medication is not appropriate. Dermatitis is relatively easy to treat but also easy to recur, so you need to observe your own situation in time.