A case study on left lower

limb cellulitis with blisters

Introduction: Cellulitis is a common, potentially serious bacterial skin
infection. The affected skin appears swollen and red and is typically painful
and warm to the touch. Cellulitis usually affects the skin on the lower legs.
Blister is an area of skin covered by a raised, fluid-filled bubble.They can
be filled with pus, blood, or serum.

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SOAP FORMAT

Demographic details:
Name: Mr.XXX
AGE: 73 YRS
GENDER: MALE
IP Number:MCIP211113597
DOA:24/11/2021
Discharge date: 4/12/2021

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 SUBJECTIVE:
A 73 years old male came to ER with a history of left lower limb
swelling with blisters , redness and local rise of temperature from 2
days.
He has a h/o similar complaints 6 months back, treated
conservatively and recovered
No h/o fever/cough/SOB/injury/trauma
COVID status: no h/o COVID 19 pneumonia – taken 1st dose of
COVID vaccine

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Past history: ? Liver disease on regular medications (Tab
sofosbuvir+velpatasvir 400/100mg)
Personal history:
smoking – nil
 Alcohol – chronic alcoholic
 Other – tobacco chewer
OBJECTIVE:
VITALS:
Blood pressure:100/60 mm of hg
Respiratory rate: 20 breaths per min
Pulse rate : 97 beats pers min
 Temp: 99.6 °f
 SPO2:98%
 GRBS :183
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 Pain score – 4 ( hurts little more)
 General examination : moderately build ,well nourished,
conscious, coherent,oriented, responding to verbal commands
 Systemic examination:
CVS – S1S2 Positive,all peripheral pulses felt
RS - BAE +, no added sounds
P/A - Soft ,bs+,no tenderness
CNS – NFND GCS – 15/15
L/E – Multiple blisters over left lower limb , redness+ ,
tenderness+,rise of temp+
Provisional diagnosis: left lower limb cellulitis with blisters.

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INVESTIGATIONS ADVICED:
 ABG
 MAJOR SURGICAL PROFILE
 Liver Function test
 Blood culture
 Hrct chest screening
 Bilateral lower limb arterial and venous Doppler
 Wound swab
 ECG
 CUE
 2d echo
 Chest x ray

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Investigations:
USG beside abdomen and pelvis:
Coarse liver parenchyma
 Well defined iso-hyperechoic lesions in the right lobe of liver
 Splenomegaly
COMPLETE BLOOD PICTURE:
Component 25/11/2021 26/11/2021 Reference range

Hemoglobin 9.1 8.6 13-17 g/dL

RBC 3.2 3.0 4.5-5.5 10^6/uL

PCV 28 27 40-50%

WBC 12.9 16.4 4.0-11.0 10^3/uL

Platelet count 130 135 150-400 10^3/uL 8

 Liver Function Test

Component Observed value Reference range

Tot. Bilirubin 3.71 <1.2mg/dL

Direct bilirubin 2.69 <0.20 mg/dL

Indirect bilirubin 1.02 <1.0mg/dL

Total protein 5.5 6.0-8.0

Creatine 1.46 3.5-5.2

Serum sodium 128 136-145mmol/L

Blood urea 89 16.6 -48mg/dL

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CT HR Chest:
 Faint homogeneous ground glass opacities With subpleural fibrotics
independant aspects of bilateral lung parenchyma- Basal congestion
 Cirrhosis of liver with suspicious focal lesion in right lobes
 Mild splenomegaly
Medications
Drug brand Generic Dose Route of Frequency No of days
name name administrati given
on
Magnex Sulbactum+ 1.5g IV BD 24/11 to
forte Cefoperaxo 30/11
ne
Clindam Clindamycin 600mg IV Bd 24/11 to
30/11
Merrim IV Meropenam 1gm IV TID 29/11,30/1
1
Pan Pantoprazol 40mg IV OD(mrng) 24/11 to
e 30/11
Optineuron Thiamine+ 1 amp IV OD(after) 24/11 to 10

vitB6+vit B2 30/11
Assessment:
 The chief complaint of the patient that is Left lower limb swelling with
blisters, redness and local rise of temperature are sign of cellulitis
with blisters
USG bedside abdomen and pelvis showed
coarse liver parenchyma which may be due to chronic alcoholism
1. Well defined iso-hyperechoic lesions in the right live of liver may arise
from benign and melignant entities.
CT-HR chest showed
2. Faint homogenous ground glass opacities with subpleural fibrotics
which may be a sign of any king of lung infection
3. Cirrhosis of Liver (may de due to alcoholism)

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 Abnormal values of LFT may be due to cirrhosis
 Magnex forte is a combination of cefoperaxone and sulbactum (which acts by
inhibiting the cell wall synthesis) is given to treat infection
 Clindamycin
 Pantoprazole is a proton pump inhibitor given as prophylaxis
 Optineuron is a combination of thiamine,vit B6, cyanocobalamin,vit
B2,nicotinamide which provides essential nutrients for proper functioning of
organ
 Meropenam is an antibiotic (which shows its its bactericidal effect by
inhibiting the cell wall synthesis) generally used to treat skin infections

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PLAN:
COMMUNICATION WITH DOCTOR:
 Magnex forte may causes anemia.So regular monitering of blood levels is
necessary.
 The combination of clindamycin and sulbactum may result in a higher
incidence of diarrhea than with either drug alone. The mechanism may be
related to additive effects on the gut microflora.
COMMUNICATION WITH PATIENT:
 Maintain hygienic conditions to avoid infections
 Avoid touching the wound site
 Avoid scratching of wound

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