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A 20 year old lady with a discharging sinus in her arm

Patient name :   ABELMOSCHUS480ESCULENTUS



History and clinical images posted (after taking informed consent from the patient) by Father Thomas, RDSS, Silwani and Chindwara on May 8, 2013

A 20 year old lady complains of a wound on the upper side of left arm.

It started four years back . Some doctors say it has affected the bones as well.

It started when on an evening the whole hand became swallen. she was taken to some local medical practioners . After some one month, the swelling was gone. but there is a persistent wound in the same area.

now when i saw the case it was not healed and pus was flowing out of it. One year back one more  wound had appeared out just below the current one.

Please give your  suggestions I am attaching the  prescription of the doctors from the government hospital at Chhindwara. they have asked her to go to Nagpur Medical College.

Health professional summary from PCMS, Bhopal ( Brajesh Sisodiya, Medical Student, Arijit Saraf, Intern, Rajesh Patel, Resident, PGY1)

Lady aged 20 presented with following complaints:
 
1.swelling over left arm since 3yrs. accompained with mild pain

2.pus discharge from sinus  foul smelling from upper 1/3 of arm and lower latral aspect of left arm since 2.5 yrs

there was no h/o of trauma and fever and no restricted movement of shoulder.
   o/e : gen :afebrile, pallor +nt foul smelling purulent discharge present .all vitals normal, hb:8g/dl,esr :42 mm
on systemic examination: nad 
advised for sinogram ,x ray: a.p ,lat view left arm ,pus culture c/s, afb staining and afb culture (using lj medium)
x ray revealed Large sequestrum with  involcrum along with metaphyseal flaring and diaphyseal involvement
sinogram : revealed long irregular sinus tract running in medullary cavity sinus tract open.
pus culture c/s: e.coli growth seen predominately  along with some gram positive cocci .
Pus for afb  stain nt seen AFB C/S sent and awaited
advised : plan for excision of sinus tract with cement and nail fixation with impegnated antibiotics
t/t given :ofloxcin 200 mg od for 2 mnths  
 

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