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Abstract: This patient is a 72-year-old male who presented to the clinic with a primary cause of erythema and pain and erythema of the right lower extremity. The patient took his own medication at home, but his condition did not improve significantly. Routine blood tests after consultation returned elevated leukocytes, neutrophils, and C-reactive protein, suggesting the presence of infection. Based on the patient’s physical signs and examination, he was diagnosed with dermatophytosis and was given medication and helium-neon laser irradiation. After active treatment, the patient’s symptoms disappeared and he recovered.
Basic information】Male, 72 years old
Disease Type】Dangiosis
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of consultation】November 2021
Treatment plan】Intravenous medication (sodium penicillin for injection) + helium-neon laser irradiation + physical therapy (ice on the affected area)
Treatment period】7 days of hospitalization and regular follow-ups
Results】Redness and pain in the right lower extremity disappeared and the condition was cured.
I. Initial consultation
The patient, Mr. Wang, suddenly developed redness and pain in the right lower limb with no obvious cause and erythema 3 days ago, but the patient did not seek immediate medical attention at that time, but chose to take oral Huang Lian detoxification tablets on his own, and since his condition did not improve significantly after taking the medicine, he came to our hospital.
Our preliminary examination of the patient showed that the patient had a normal body temperature, red skin on the right lower extremity, local swelling, tension and shine on the surface of the swollen part of the skin, higher skin and tenderness, and a swollen lymph node with tough texture and tenderness was palpated in the right inguinal area. The patient underwent routine blood tests, which showed elevated absolute values of leukocytes, neutrophils, C-reactive protein, and neutrophil ratio, suggesting the presence of infection. Combining the patient’s medical history, symptoms, and ancillary examinations, the initial diagnosis of dermatophytosis was made at the outpatient clinic, and considering the patient’s age, he was admitted to our department for further treatment.
II. Treatment process
After admission, the patient continued to improve relevant examinations and strictly monitored vital signs. Because the diagnosis of dermatophytosis mainly relies on laboratory tests to find the pathogenic bacteria and combined with clinical characteristics to make a clear diagnosis, two skin scrapings were taken from the red and swollen infected area of the patient’s right lower extremity and sent to bacterial culture.
We communicated with the patient and his family and initially considered intravenous medication and laser irradiation treatment. After the family members understood the treatment plan clearly, they expressed positive cooperation with the treatment. Since the patient had no previous history of penicillin allergy, after confirming that the skin test showed no abnormalities, the patient was given sodium penicillin for injection in an IV drip for anti-infection treatment, and helium-neon laser irradiation treatment and local ice for pain relief. After 7 days of hospitalization, the patient improved significantly, the biochemical indexes were basically normalized, and the skin lesions were relieved significantly, so the patient was discharged from the hospital for recuperation.
III. Treatment effect
After the patient was clearly diagnosed with dermatophytosis in our hospital, we gave timely treatment. After 3 days of treatment, the patient’s pain in the right lower limb was relieved and no significant change in the color of local erythema was observed, so the treatment continued according to the original plan. On the seventh day of hospitalization, the patient complained that the pain in the right lower limb was greatly reduced, the color of the erythema became significantly lighter, the redness and swelling basically subsided, and there was no skin breakdown. One week after discharge, the patient came for a review, at which time it was seen that the local skin of the right lower limb was free of erythema, the erythema had basically disappeared, and there was no pain.
IV. Notes
I was happy that the patient recovered after treatment. However, since the patient was not completely cured when he was discharged from the hospital, and dermatophytosis is often easy to recur, the patient should also pay attention to the following points after discharge.
1, dermatophagoides is a disease prone to recurrence, must ensure that the full dose, full course of medication in order to eradicate, so patients should strictly follow medical advice after discharge, continue to use antibiotic treatment for 1 week, do not stop the drug, 1 week after the timely review to our hospital, the review pay attention to fasting, according to the results of the review to further adjust the medication.
2, patients should pay attention to daily life care after discharge, more bed rest, limit activities, elevate the right lower limb when lying in bed, promote local blood and lymphatic reflux, avoid skin breakage of the right lower limb. At the same time, patients need to pay attention to local skin cleanliness and hygiene to avoid infection. If abnormal symptoms appear, medical treatment should be sought immediately. After basic recovery, elastic stockings can be worn for a period of time to consolidate the treatment effect.
3. Patients should improve their living habits appropriately, quit smoking and drinking, maintain a healthy diet, and supplement more high-quality protein and multivitamins to promote physical recovery.
V. Personal insight
Danemia, commonly known as runny fire, is mostly caused by Streptococcus b haemolyticus infection, which is an acute infectious skin disease, often affecting the skin surface, lymphatic vessels within the subcutaneous tissue and surrounding soft tissues, mostly in the lower extremities and facial areas, just like the patient in this article, showing local skin redness, swelling, heat and pain, with clearly defined red spots.
After the discovery of dermatophytosis, it must be treated as soon as possible, otherwise it will not heal and will be very easy to recur, especially in elderly patients, who have poor health and are significantly affected by the disease. The patient in this article was diagnosed because of his old age, so after the diagnosis was confirmed, he was immediately arranged for a full dose and course of antibiotic treatment, and the inflammation was quickly contained and the symptoms gradually subsided, which eventually led to the eradication of the disease and a deep sigh of relief for the patient and his family. In addition, if there are similar manifestations of dengue as this patient in the clinic, you should not be careless and must go to the hospital in time to get effective treatment in the shortest possible time.