A 55yr old male patient with left sided pedal edema since 2 months

The complete case can be found here

Presenting complaints
1. unilateral leg swelling from 2 months and pain in gluteal region on left side

diffrential diagnosis
1. DVT
2. cellilitis and compartment syndrome
3. gastronemius tear it is unlikely because it ts often also has pain in the posterior aspect of leg
4. ruptured bakers cyst

And a draining pus suggests cellulitis is more lokely

To investigate the diagnosis tests required are

1. for DVT

Preliminary wells DVT score can also be used to predict DVT

D- dimers high sensitivity low spesificity

ultrasound scan leg

2. for cellulitis and compartment syndrome
Pus shold be sent for culture and antibiotic sensitivity
complete hemogram to assess WBC count, DLC, anaemia
urine and blood culture and antibiotic sensitivity
renal function tests and arterial blood gas to assess sevearity of this patient

3. Other general tests for general baseline workup
RBS
HbA1c
ECG
Chest X-ray PA
Serology
Serum. Iron
Reticulocyte count


Inference form above investigations
  1. patient's lower limb dopler is negetive for DVT
  2. pus culture and sensitivity isolates klebsella pneumoneae with poly antibiotic resistance
  3. patient is anemic iron levels are normal so this could be anaemia of chronic disease this should be confirmes with TIBC and serum ferritin levels reference:http://www.irondisorders.org/anemia-of-chronic-disease
  4. patient is having metabolic acidosis and compensatory respiratory alkalosis. reference: current medical diagnosis and treatment 2020 table 21-13.
  5. acute kidney injury secondary to lower linb cellulitis reference: https://cjasn.asnjournals.org/content/8/4/658

Treatment
Inj metrogyl
inj vancomycin 
tab pantop
lower limb elevation
regular dressing

klebsiella pneumoniae
They are nonmotile and nonsporing. They are arranged singly or in pairs. Freshly isolated strains show a well-defined polysaccharide capsule.

the antibiotic sensitivity report suggests infection caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella strains

Contact isolation is useful for patients colonized or infected with highly antibioticresistant Klebsiella strains, such as ESBL-K. pneumoniae

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