A 75 year old man presented to the OPD with pain swelling and blisters on ankle and leg on left side

Hello everyone. I am Shruthika, a third year MBBS student

This is an online E logbook to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through a series of inputs from the available global online community of experts intending to solve those patients' clinical problems with collective current best evidence-based inputs

CHIEF COMPLAINTS

A 75 year old man who is a farmer by occupation from Villamla presented to the OPD with complaints of pain and edema in the right ankle and foot which gradually progresses upward towards the groin. He also complaints of immobility in the foot. 

HISTORY OF PRESENTING illness

The patient developed the same situation 2 years back when a thorn pricked him on the medial side of his left leg and led to an infection.on visiting a local RMP, he was put on medication and the site was properly cleaned with warm water. He went back to normal after that. 
the patient was apparently asymptomatic 1 week back. Then he observed unilateral swelling in his right ankle and foot. Gradually it progressed to his leg and then to his thigh.the patient describes the pain to be a burning type of pain. He had taken no medication for the pain. However, he applied jhandu balm on the site which led to formation of blisters according to the patient. After being sdmitted in kims hospital, he had burning micturition and black urine which subsided on medication

History of past illness
No diabetes
No hypertension
No thyroid
No asthma
No cad
No epilepsy
No surgical history
No blood transfusions
Patient randomly takes pain medication on limb pains

PERSONAL HISTORY

married
Mixed diet
Works as a farmer
Normal bowel
Normal bladder
Alcohol addiction 
Quit 15 days ago
Smoker
No other addiction

General examination


Patient is conscious, coherent and cooperative
Well versed with time space and people around
No palor
No icterus
Clubbing of fingers present
No lymphadenopathy
No central cyanosis
No peripheral cyanosis
No erythema
Unilateral swelling and blister on right foot radiating to leg and thigh gradually to groin

Treatment protocol

Normal diet
Inj. Monocef iv BD
Inj. Metrogyl iv TID
Inj pan 40 BD
Tab limcee
Tab dolo 650 

Foot end elevation
DAY 2 MY OBSERVATIONS
PATIENT SAYS BURNING PAIN HAS REDUCED. 
HOWEVER, HIS SKIN SEEMS TO BE PEELING OFF. BANDAGE REMOVED FOR CLEANING AND REBANDAGING DONE. 
Day 2..observations

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