His complete blood count with differential is within normal limits. Doppler studies fail to reveal venous thromboses. Patient was prescribed 7 days of oral antibiotics and sent home. The patient returns after 3 days with no improvement in his symptoms.
What is the diagnosis and why did he not respond to antibiotic treatment?
Answer: This patient is a classic case of Stasis dermatitis which is often misdiagnosed and treated as cellulitis. Stasis dermatitis is a chronic dermatitis of the lower extremities that results from chronic edema. It can start relatively abruptly and be unilateral or bilateral.
As there is no underlying infection patient did not respond to the antibiotic treatment. The goal of therapy is directed at resolution of the edema. Patients must lose weight and employ a strict routine of compression hose and leg elevation. In the short term, topical corticosteroids can improve
the inflammation.
Case Discussion:
Stasis Dermatitis is the inflammation of the skin of the lower legs caused by chronic venous insufficiency.
Clinical features; Patients may have following signs and symptoms:
- Swelling of the leg
- Pain and tenderness in the calf.
- Redness and brownish discoloration of the skin of the calf and ankle.
- Ulceration of the skin.
- Sometimes open sores and ulcers.
Diagnosis: is usually clinical. Doppler studies may be done to rule out venous thrombosis.
Treatment: Patients are instructed to :
- avoid prolonged standing and sitting
- prop up the legs when sitting
- wear compression stockings.
- topical steroid creams and ointments may help reduce the inflammation.
- If an ulcer develops it should be treated with dressings and antibiotics if needed.
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