Limb pain
Sherif Gonem, Ian Pavord in Diagnosis in Acute Medicine, 2017
Acute limb pain is most commonly caused by arterial occlusion, deep vein thrombosis or cellulitis. A subacute or chronic course may be caused by chronic arterial or venous insufficiency, but may also result from metabolic bone disease, malignant bone infiltration or neuropathy. The mechanisms of limb pain may be summarised as follows: impaired arterial blood supply; impaired venous drainage; infection, inflammation or trauma; metabolic muscle or bone disease; neoplasia; and neuropathy. A cellulitic-looking leg with pain and/or systemic illness that is out of proportion to the clinical features should prompt consideration of more serious infections such as necrotising fasciitis, and referral for an orthopaedic opinion. Consider compartment syndrome if a limb that has recently undergone trauma or fracture develops disproportionate pain and/or symptoms and signs of ischaemia, such as paraesthesia, pallor, absent pulses, paralysis and cold peripheries.
Skin, soft tissue and bone infections
Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar in Handbook of Refugee Health, 2021
Skin, soft tissue and bone infections are common and important among refugees, who may have been injured during conflict, violence or humanitarian disaster or during the often-dangerous journeys taken to reach safety. Injuries may also occur in the often-unsafe refugee camp settings or the poor housing in which they may reside; this is impacted by poor access to water and sanitation. In stable refugee camp settings, presentations with infected insect bites and cellulitis are not infrequent. In some settings, prosthetic material, for example, internal fixation, may be used after injury.
Dermatology
Kristen Davies in Core Conditions for Medical and Surgical Finals, 2020
The differential diagnosis of atopic eczema includes psoriasis, allergic contact dermatitis, seborrhoeic dermatitis or a skin infection. Eczema is chronic, inflammatory skin condition characterised by papules and vesicles on an erythematous base. The aetiology of eczema is fully understood but factors such as genetic predisposition, dysfunction of the skin barrier and immune system dysfunction are thought to play a part. Atopic eczema typically presents as an intense, itchy, erythematous rash on the flexure surfaces, sparing the groin and axillary regions. The rash typically starts in childhood and is episodic in nature. Patients classically present with well-demarcated raised erythematous scaly plaques on the extensor surfaces and scalp. The differential diagnosis for psoriasis includes eczema, seborrhoeic dermatitis, fungal skin infection, cellulitis, secondary syphilis, lichen planus and discoid lupus erythematosus. Guttate psoriasis may present similarly to pityriasis rosea. Basal cell carcinoma is cancer derived from the basal cells of the epidermis.
Procalcitonin and cellulitis: correlation of procalcitonin blood levels with measurements of severity and outcome in patients with limb cellulitis
Published in Biomarkers, 2019
R. J. Brindle, A. Ijaz, P. Davies
Background: Procalcitonin levels may be raised in bacterial infections and have been used to guide antibiotic therapy. There is little data on procalcitonin and limb cellulitis. Objectives: Within a clinical trial of antibiotic therapy, we examined the correlation between clinical observations, blood tests and local measurements of skin damage, with serum procalcitonin levels. Methods: The data is from a subset of the patients recruited into a clinical trial of antibiotic therapy for cellulitis (clindamycin for cellulitis, NCT01876628) whose procalcitonin levels were correlated with clinical and laboratory measurements. We selected the variables strongly correlated with procalcitonin and evaluated the predictive value of the baseline procalcitonin on the primary trial outcome. Results: 136 patients provided 307 procalcitonin levels which were correlated with 8 variables. The strongest correlations (correlation coefficient of >0.5) with procalcitonin were the affected skin area (0.537), C-reactive protein (0.574) and neutrophil:lymphocyte ratio (0.567). Receiver operator characteristic curves demonstrated poor sensitivity and specificity of procalcitonin in predicting primary outcome. Procalcitonin baseline levels were low but decreased as patients recovered. Conclusions: Procalcitonin levels are generally low in limb cellulitis and cannot be used to confirm the diagnosis or the need for antibiotic therapy. Procalcitonin is a poor predictor of early improvement.
Intracranial Infectious Aneurysm in Orbital Cellulitis
Published in Orbit, 2015
Brian Lee, Charles Kim, Jacqueline Carrasco
Infectious intracranial aneurysm and cavernous sinus thrombosis are rare complications of orbital cellulitis. We report the case of a 46-year-old male presenting with sinusitis and orbital cellulitis complicated by the development of an orbital mass. Following orbitotomy with debulking, the patient underwent bony orbital decompression for increasing proptosis postoperatively. While his exam stabilized, the patient developed complete ptosis and extraocular motor palsy in the contralateral eye after undergoing bilateral sinus debridement. Imaging was notable for the presence of a pseudoaneurysm of the internal carotid artery, which was treated with a stent. This report demonstrates rare complications of orbital cellulitis. These patients should be monitored carefully with noninvasive imaging studies, such as cerebral angiography, for early detection of vascular abnormalities that can progress rapidly.
Periorbital (preseptal) cellulitis in children
Published in Expert Review of Ophthalmology, 2008
Infections of the eye can be periorbital (preseptal) or orbital in origin. The management of children with periorbital cellulitis varies with the clinical presentation. Some children have trivial or self-limited disorders, while others can have sight- or life-threatening problems. Thorough physical examination helps the clinician to differentiate among the causes of periorbital cellulitis and between periorbital and orbital cellulitis. The differential diagnosis of periorbital cellulitis includes conjunctivitis, hordeolum, dacryocystitis, dacryoadenitis, bacteremic cellulitis, traumatic cellulitis and inflammatory edema secondary to sinusitis. Orbital cellulitis, although very much less common than periorbital cellulitis, is the most common cause of unilateral proptosis in children.
Related Knowledge Centers
- Connective Tissue Diseases
- Exophthalmos
- Pain
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- Suppuration
- Eyelids
- Orbit