Cheif complaints :
A 65 year old male came to opd with the chief complains of painful wounds on right leg since 20 days.
History of presenting illness
Patient was apparently alright 20 days back, then complained of swelling and painful skin lesions over both legs.
History of prior treatment in govt hospital.
Framycetin cream was given
Left leg lesions have subsided, but the right leg lesions continued with discharge.
Past history
He tells us that all his problems started in 2019 when he started experiencing lower back pain radiating to bilateral thighs. He says he used to experience tingling and numbers in both his lower limbs for which he went to a local doctor and was diagnosed with L4-L5, L5-S1 disc prolapse and he underwent L5 laminectomy + and L5-S1 discectomy
Following that surgery he was unable to wear the footwear.
1 year after the surgery he started experiencing difficulty in urination.
2 months back- he gradually developed swelling of his bilateral lower limbs followed and swelling of his upper limbs. When he went to a local hospital . He was treated there for 12 days and edema decreased and was sent home.
But he started having SOB (NYHA-4) visited another hospital again and he was treated for 1week then his dyspnea subsided.
During these 2 months he also was diagnosed to be a diabetic and was started on Tab Metformin 500mg twice daily.
25 days back he developed these painful lesions associated with swelling which started in the ankle and then extended upto the knees for which he went to Govt Hospital. There is a history of discharge from the lesions. After applying the medication lesions have resolved in left leg and swelling also resolved in that leg.
No significant family history.
Personal history
Diet and appetite are normal.
Sleep is adequate.
He has been consuming 90-180ml of whiskey every 3 days in a week since the past few years
Micturition is decreased.
Examination
On inspection...
Swelling and multiple ulcers were seen on the right leg and pigmentation is seen around the ankle region.
On palpation..
Ulcers were tender and there is decreased temperature on the right leg below the knee compared to other leg.
There is decreased sensation in the legs.
CVS Examination :
His apex beat is in the left to the MCL.
S1,S2+
CNS -Normal.
Lungs - clear on auscultation.
Abdominal Examination -Bowel Sounds Heard.
Provisional Diagnosis :
Diabetic dermopathy
Vasculitis??
Diabetic Neuropathy.
Treatment
Fusidic acid cream bd for 1week morning and night.
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