Texila American University

Case Report Format

Student Name: Dr. Shahzad Ahmad

Program/Specialization: M.M.S.CFamily Medicine

Hospital/Clinic Name: Salabiakhat Centre

Year of Study: 3rdSemester 2016

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INSTRUCTIONS
 All the fields are mandatory.
 Each field carries mark.
 Type the details in the respective columns.

EVALUATION CRITERIA
CRITERIA MARKS PROGRAM CHAIR
MARKS
Title 5
Abstract and summary 10
History 15
Examination 15
Diagnosis / Differential diagnosis 5
Investigations and interventions 10
Treatment 10
Discussion 15
Learning points 5
References 5
Communication and presentation 5
TOTAL MARKS 100

PROGRAM CHAIR COMMENTS:

PC’s SCORE
FURUNCULOSIS OUT OF 5
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Case Report Format
ABSTRACT- PC’s SCORE
OUT OF 5

4.5 years old male child brought by his parents to our Salabiakhat family specialized
health care center for having multiple pustular skin lesion on upper and lower
extremities and on scalp from the last 10 days .Complete examination was performed
and diagnosis make clinically of furuncolosis and treatment with antibiotic and
advices to the parents and follow-up

HISTORY
PC’s SCORE
Name:Zeshan
OUT OF 15

Age : 4.5

Chief Complain
4.5 years old male child brought by his parents to our Salabiakhat family specialized
health care center for having multiple pustular skin lesion on upper and lower
extremities and on scalp from the last 10 days

History of Present illness

Parent has notice the child having multiple pruritis pustules on scalp and upper and
lower extremities from last 10 days which gradually increasing in size and number
from the first day of its appearance and did not associated with any other symptoms
like, fever, nausea vomiting, cough diarrhea and child was not given any medication
at home for this rash and pustule.

Past Medical History

Frequent episodes of sore throat and upper respiratory tract infections

Family History
No significant family history

Birth History
Full term normal vaginal delivery ,birth weight of 2.8 kg

Vaccination
Vaccination is up to date
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Case Report Format
EXAMINATION

On Examination

child is active , cooperative and responsive

vital signs

Temperature : 97.5°F
Blood pressure : 130/90 mm Hg;
Pulse : 78 beats/min
Respiratory rate: 25breaths/min.

ENT: normal

HEAD &NECK: normal

HEART: normal
PC’s SCORE OUT
HEENT: No headache ,congestion or epistaxis OF 15

RESP: No cough /wheeze

CARDIAC: No chest pain /cyanosis/palpitation

ABDOMEN: No abdominal pain , diarrhea or constipation, soft, non-tender, no

organomegaly

GU: none

SKIN: multiple furuncles with size of 1 into 1 and 2 into 2 and lesions on different
stage of healing concentrated on the scalp and upper and lower extremities.

EXTREMITIES: no swelling/effusion , normal

NEURO: No weakness or seizure

 Texila American University
Case Report Format
DIAGNOSIS : FURUNCULOSIS
DIFFERENTIAL DIAGNOSIS
1:Foliculites
2:Fungal infection (tinea) PC’s SCORE
OUT OF 5
3:Herpes simplex virus
4:Infected sebaceous cyst
5:Eczema
6:Dermatites

INVESTIGATIONS / INTERVENTIONS

Diagnosis of furuncolosis is completely clinical however

PC’s SCORE
1:culture of the purulent contents can be done
OUT OF 10
2:immunoglobulin level in rare cases for example recurrent or inexplicable
3:if culture grow gram-negative bacteria or fungus consider polymorphonuclear
neutrophil leukocyte functional defect

Other routine investigation can be done

TREATMENT

1: Cloxacilin Suspension 0.6ml every 8 hourly for 1 week is given

2:Mycostatin ointment is given to applied twice daily on the lesion for one 1 week
3:Advices to the parent to give daily bathing with antimicrobial soap with change of PC’s SCORE OUT
clean cloths daily OF 10
4: Education for parents regarding unhygienic conditions.
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Case Report Format
DICUSSION PC’s SCORE OUT
OF 15

Furunculosis is a deep infection of the hair follicle leading to abscess formation with
accumulation of pus and necrotic tissue. Furuncles appear as red, swollen, and
tender nodules on hair-bearing parts of the body, and the most common infectious
agent is Staphylococcus aureus, but other bacteria may also be causative. In some
countries, methicillin resistant S. aureus is the most common pathogen in skin and
soft tissue infections which is problematic since treatment is difficult. Furunculosis
often tends to be recurrent and may spread among family members. Some patients
are carriers of S. aureus and eradication should be considered in recurrent cases.
Solitary lesions should be incised when fluctuant, whereas patients with multiple
lesions or signs of systemic disease or immunosuppressant should be treated with
relevant antibiotics. The diagnostic and therapeutic approach to a patient suspected
of staphylococcus should include a thorough medical history, clinical examination,
and specific microbiological and biochemical investigations. This is particularly
important in recurrent cases where culture swabs from the patient, family members,
and close contacts are mandatory to identify and ultimately control the chain of
infection. Focus on personal, interpersonal, and environmental hygiene issues is
crucial to reduce the risk of contamination and recurrences.

REFERENCES PC’sSCORE OUT

OF 5
1: Dahl MV. Strategies for the management of recurrent furunculosis. South Med J.
1987; 80:352–356.

2: Pottinger PS. Methicillin-resistant Staphylococcus aureus infections. Med Clin

North Am. 2013;97:601–619

3: Frazee BW, Lynn J, Charlebois ED, Lambert L, Lowery D, Perdreau-Remington F.

High prevalence of methicillin-resistant Staphylococcus aureus in emergency
department skin and soft tissue infections. Ann Emerg Med. 2005;45:311–320

4: Al-Tawfiq JA, Aldaabil RA. Community-acquired MRSA bacteremic necrotizing

pneumonia in a patient with scrotal ulceration. J Infect. 2005;51:e241–e243

5: Bahrain M, Vasiliades M, Wolff M, Younus F. Five cases of bacterial endocarditis

after furunculosis and the ongoing saga of community-acquired methicillin-resistant
Staphylococcus aureus infections. Scand J Infect Dis. 2006; 38:702–707.
 Texila American University
Case Report Format
COMMUNICATION AND PRESENTATION PC’s SCORE
OUT OF 5
Furunculosis is a deep infection of the hair follicle leading to abscess formation with
accumulation of pus and necrotic tissue. Furuncles appear on the hair-bearing parts of
the skin and the infectious agent is Staphylococcus aureus. However, other bacteria
may also be causative. Furunculosis occurs independently of methicillin resistant S.
aureus (MRSA) infection, which has become endemic in some countries. MRSA are
more difficult to treat with standard antibiotics and hence pose a specific clinical and
microbiological problem, which is dealt with in great detail elsewhere and will
therefore not be described in detail here