A 63-year-old man with severe lesions in the right foot

Authors : Vitorino M SANTOS, Zilcem C ARRUDA JUNIOR, Daniela G GEBRIM, Fabio H O SILVA, Daniele A RECKZIEGEL

Pages : 149-150

View : 17 | Download : 9

Publication Date : 2014-05-20

Article Type : Other Papers

Abstract :A 63-year-old man was hospitalized because of severe lesions in his right foot insert ignore into journalissuearticles values(Figure 1A);. These evolved with minor pain and had first been observed approximately ten days before admission. The changes were initially limited to the plantar surface of the second toe, but the patient did not remember any recent trauma, because of a chronic loss of local sensibility. Remarkable antecedents were metabolic syndrome, arterial hypertension and type 2 diabetes, which were controlled by another service by diet in addition to metformin, gliclazide, and losartan. Two years previously, he had undergone a surgical procedure involving the distal area of the first right toe. His mother 83-years of age had had an amputation of part of the left extremity caused by similar conditions. Notwithstanding, he did not get enough knowledge about the selfmanagement in this setting. He denied tobacco smoking, but confirmed social alcohol consumption. His evaluation on admission showed body mass index insert ignore into journalissuearticles values(BMI); 28.8 kg/m2, waist circumference 110 cm, and arterial pulses in the lower limbs of decreased amplitude. The rest of the physical examination was unremarkable. Routine blood tests showed moderate anemia, mild neutrophil leukocytosis, elevated erythrocyte sedimentation rate insert ignore into journalissuearticles values(ESR); and C-reactive protein insert ignore into journalissuearticles values(CRP); level, hyperglycemia, hypoalbuminemia, and high urea and creatinine levels. Cultures from samples of the foot wounds revealed S. aureus sensitive to clindamycin and ciprofloxacin, and these drugs were administered. The imaging studies of the affected foot disclosed bone and arterial changes insert ignore into journalissuearticles values(Figures 1B and 2);. The patient underwent a surgical procedure on the day 4 of admission, and the blood control tests showed an improvement of hematological indices and normalization of renal function. After hospital discharge, he is under specialized surveillance at the orthopedic rehabilitation service.
Keywords : lesion, foot