A 45-yr old man presents with this painful lesion for a month's duration. It started out as a scratch from a fall and has progressed to what it is now.
Q1: What type of skin infection is this?
Q2: What is the best form of treatment?
Q3: What systemic condition might predispose to it and how should it be investigated?
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7 comments:
Dear CC
Interesting answers you have given me. Things I myself did not consider when managing this patient - like actinomycosis.
You are quite right that TB should be ruled out.
From the appearance - multiple discharging sinuses and the wide area of diffuse inflammation, plus that it started out with trauma - should make us think of a skin infection like a carbuncle.
Also TB in the neck would usually be confined to lymph nodes and their distribution, which is not the pattern here.
The offending pathogen would be Staph Aureus or Strep pyogenes. Diabetes mellitus is the systemic condition that often underlies this poor resistance to infection and must be investigated and controlled quickly - with IV insulin infusion if necessary.
Any chance of Hand schuller christian disease(Histiocytosis X)
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