(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: Dermatophytosis is an acute inflammation of the skin and reticular lymphatic vessels caused by streptococci and is clinically characterized by sudden red, swollen, and hot skin with clear borders and a color like a painted tan, with a long treatment period. The patient in this case is a 71-year-old grandmother Liu, who visited the clinic because of fever and redness and swelling of the leg. After examination, the diagnosis of streptococcus was confirmed, and after 28 weeks of drug treatment, the swelling of Liu’s leg basically subsided, the pain was not obvious, and the affected area was crusted.
Basic information】Female, 71 years old
Type of disease】Dantoxin
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of Consultation】February 2021
Treatment plan】Medication (piperacillin sodium tazobactam sodium for injection, desmethylvancomycin hydrochloride, rehabilitation new liquid, magnesium sulfate, levofloxacin hydrochloride injection)
[Treatment period] 28 days after admission to hospital, review every 2 months
Treatment effect】The swelling of the leg basically subsided, the pain was not obvious, and the affected area was crusted.
I. Initial consultation
Grandma Liu came to the clinic on Sunday morning accompanied by her daughter. Grandma Liu said she started to have symptoms of nasal congestion and runny nose 2 days ago, and her daughter took her temperature, and she had a little fever, so she took some quick-acting cold capsules by herself, and her symptoms were slightly relieved. According to the situation, I conducted a specialist examination for Grandma Liu, and found that there was significant swelling and patchy erythema from the lower left leg to the thigh, with clear boundaries, painful to touch, and poor mobility. After questioning, Grandma Liu had a left knee arthroplasty 3 years ago and denied past history of infectious diseases, trauma, blood transfusion and drug and food allergy. Based on serum enzymatic examination, routine blood tests, and the patient’s symptoms, she was diagnosed with dengue and was recommended to be admitted to the hospital for treatment.
(Serum enzymatic examination)
(Routine blood test)
II. Treatment history
Considering that the common pathogenic organism of dengue is group A beta-hemolytic streptococcus, the patient was given a positive skin test with injectable cefoperazone sodium sulbactam, and the initial treatment plan was to choose injectable desmethylvancomycin hydrochloride for anti-infective treatment, and to use magnesium sulfate wet compress to reduce swelling. On the 3rd day of admission, the patient’s leg was still obviously swollen, and the erythema spread to the thigh, part of the erythema developed into blisters, and the disease progressed rapidly. On the 23rd day of admission, according to the drug sensitivity results, the use of levofloxacin hydrochloride injection was stopped and piperacillin sodium tazobactam sodium for injection was selected for anti-infection treatment.
III. Treatment effect
The effect of empirical treatment at the early stage was not very obvious, and the patient still complained of pain in the leg. In view of the microbiological culture result of Pseudomonas aeruginosa, the drug sensitivity suggested that P. aeruginosa was resistant to levofloxacin hydrochloride and sensitive to piperacillin sodium tazobactam sodium, according to the drug sensitivity result, piperacillin sodium tazobactam sodium for injection was selected for anti-infection treatment. The patient’s leg swelling had basically subsided by the 28th day of hospitalization.
IV. Notes
We are glad that after active and patient treatment, the swelling of the leg has basically subsided and the pain has improved significantly, but after discharge from the hospital, the patient should be reviewed regularly.
In daily life, we should pay attention to rest, limit excessive leg activities, and elevate the affected limb to reduce local swelling, and if local pain occurs again, it can be relieved by applying cold compresses.
V. Personal insight
Dermatitis is an acute inflammation of the skin and reticular lymphatic vessels caused by streptococcus bacteria, which is clinically characterized by sudden redness, swelling and pain of the skin with clear borders and color like painted pellets. The treatment cycle of dermatophytosis is long, and the choice of antibiotics needs to be adjusted according to the patient’s condition in a timely manner, just like the patient in this case, who started with empirical treatment with poor results and had obvious results after treatment with sensitive antibiotics. Patients should maintain patience and confidence, and actively cooperate with the doctor for treatment to promote early recovery from the disease. If the patient develops lower limb edema, blood and lymphatic circulation can be promoted by wearing elastic stockings.