Patient: 51 years old male
Case Scenario:
- 51 year old male patient presented with sudden onset of painful swelling on the back extending from right scapula to lumbar region (L1) for past 1 week.
- Fever off and on.
- H/O sebaceous cyst present back side (near scapula area) for 1-year duration.
- On examination he was conscious, oriented, febrile, tachycardia with tachypnea.
- Local examination: Tenderness + , inflammatory signs + , pus discharge + over the sebaceous cyst area +
- His investigation:
- Blood Sugar: 310 mgs%
- Blood Urea: 80 mgs%
- Serum creatinine: 3 mgs%
- Hb Aic :9.0%
- Total Count: 11,600 cells/cumm [P 86%, L12%,E2%]
- Hb%: 9.5 gms% Urine acetone – positive
Clinical Diagnosis:
Long standing T2 DM, # carbuncle with huge abscess back side, septicemia, diabetic Ketoacidosis, AKI on ?CKD, anaemia.
- He was admitted in our hospital and treated with broad spectrum antibiotics, Metronidazole, DKA corrected by NaHCO3, insulin infusion, iv fluids.
- After stabilization [on his 3rd admission day]
- He was subjected to incision & drainage done under GA.
- 1litre (1000 ml) pus drained out, wound debridement also done.
- Post op
- Hb 7.5 gms%, 2 units of packed cell volume also given.
- Blood Sugar: 131 mgs%
- Blood Urea: 55 mgs%
- Serum creatinine: 2.5mgs%
- Urine acetone – Negative.
- Swelling over the site gradually reduced in 5th post-operative day, and patient made a rapid recovery.
- Culture report: Enterococcus species grown in culture.
- Antibiotics given asper culture report.
- Patient discharged 12th day of admission.
- His Post Prandial blood sugar: 172 mgs%
- Blood Urea:35mgs%
- Serum creatinine:1.4 mgs%
- Hemoglobin:8.4gms%
- Patient treated in OPD, the wound was regularly cleaned, debrided.
- The wound got red granulation tissue in 4 weeks, but not covered.
- Patient re-admitted, plan for skin grafting.
- Wound culture and sensitivity done, staphylococcus grown in culture.
- IV Antibiotics given asper culture report.
- Patient already on insulin, blood sugar under control.
- Urea, creatinine normal, Hemoglobin:10.7gms%.
- Under GA, Skin grafting done by plastic surgeon.
- Donor & recipient site healed very well (see the photo) on 15th day of Skin grafting surgery.
- This patient later on could be managed on oral antidiabetics drugs.
