This is an elderly diabetic patient, with facial lesions and fever.

facial lesions

The patient is a type 2 Diabetic patient for the last ten years on metformin and premixed insulin twice daily. His blood sugars are mostly in the range of 200 to 300 mg/dl and glycated haemoglobin of 9.8 %.

Five days back he developed facial itching followed by redness, swelling and the lesions as seen in the picture. He developed a high-grade fever associated with it and could not open the eyes. Vision in both the eyes was normal. cranial nerves could not be properly assessed but seemed unremarkable. Power and reflexes in both the limbs were normal and planters were bilaterally down going.

Q:

  1. What is the diagnosis?
  2. How should this patient be managed?

bilateral lower limbs dvt

Follow up of our patient …

Our patient was treated on the lines of infected herpes zoster (shingles).

He was started on intravenous acyclovir, Vancomycin and piperacillin-tazobactam. He responded well to treatment and was discharged after seven days of treatment.

A brief discussion about Herpes zoster (shingles) will be posted in the next few days.


Read More …

  1. Diagnose this patient with hypertension
  2. A young patient with bilateral lower limbs weakness
  3. A young man with fever, arthritis and renal failure

 

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Dr.ijaz ali
Dr.ijaz ali
2 years ago

D/Ds should be orbital cellulitis, mucormysis , herpes zooster infection.
Do his CBC , xray PNS , sinuses fluid fungal culture.
Gylceamic controle and empirically fluroquinolones with anti-fungal. CT PNS WITH CONTRAST in plan.
ENT and Eye opinion

Dr israr ahmad cheema
Dr israr ahmad cheema
2 years ago

Cellulitis