感染症診療の原則

研修医&指導医、感染症loveコメディカルのための感染症情報交差点
(リンクはご自由にどうぞ)

Boot camp day #5: Saw a Ghost

2019-12-06 | 青木語録

80 some year old woman with history of diabetes, hypertension, and heart failure with long standing edema in bilateral lower extremities fell down a few days prior to admission. She SAW A GHOST at that time.
She had been in her usual state of health till then and was completely independent buying daily necessities/stuff at the grocery store near by. Presenter emphasized a fact that she never used convenience store.

A few days later she was found lying down unresponsive on the floor unable to walk with subQ hemorrhage in left periorbital region.
On arrival, she could not communicate well with slightly fast pulse, respiratory rate, and low grade fever. She was anemic with +/- lymphadenopathy in her neck. Chest and abdominal exam were not remarkable. She had chronic looking bilateral lower leg pigmentation with multiple small ulcers. No discharge nor bad odor were noted.

Lab. and Imaging studies: CBC and Chem. were unremarkable except low hemoglobin, low sodium of 130. CXR showed slight density of unknown nature/significance in her right upper lung region. . Ultra sound of lower extremities showed no DVT. CT of the head and neck showed no major abnormalities.

My way of thinking:
DM in aging population ⇒ Needs more precise imaging with contrast to find purulent lesion. We also have to look for the microbial agents that get advantage in cellular immunity deficiency by having appropriate specimens.

CT with contrast showed multiple abscesses here and there, osteo, and so on.

Blood cultures were positive 4 out of 4 bottles for non-typhi Salmonella.

Presenter : Drs. Takahashi and Shiiki

この記事についてブログを書く
« Boot camp day #4: 89 year o... | トップ | Boot camp Extra Edition #1: »
最新の画像もっと見る

青木語録」カテゴリの最新記事