Issue: 2016 > March > photo quiz

Reactions and complications to bites

Y. Yurumez, Y. Yavuz, M. Yucel, Z. Cetinkaya, I.H. Ciftci
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A 46-year-old female patient who lived alone, with a poor personal hygiene, was admitted to the our emergency department because of cough, anorexia, weakness, bloody pituitary, and a wound on the ankle. It was learned that the patient had consulted physicians several times for the lesions and had been treated with topical medicines and oral antibiotics.
On physical examination, she was conscious, and cooperative. Her body temperature was 38.2 °C, pulse rate 81 beats/min, blood pressure 100/80 mmHg and respiration rate was 26 breaths/min. Her body had widespread excoriation related to itching, petechial bleeding and haemorrhagic papules on uncovered parts (figure 1). Crepitant rales were heard at the lower and centre zones of her right lung. There was a 10 x 8 cm necrotic wound on and around the lateral malleolus of her right ankle and the medial malleolus was uncovered (figure 2). Local warmth and oedema were observed on the back of foot.
The laboratory results were as follows: haemoglobin 8.2 g/dl, haematocrit 25.9%, white-cell count 16 x 103 /µl, thrombocytes 67 x 103 /µl, prothrombin time 16.2 sec, activated partial thromboplastin time 42 sec, fibrinogen 78.7 mg/dl, d-dimer 4.7 mg/dl, creatinine 3.4 mg/dl, urea 91.8 mg/dl, sodium 129 mEq/, chlorine 96.2 mEq/l, aspartate aminotransferase 472 U/l, alanine aminotransferase 163 U/l, creatine kinase 2599 U/l, creatine kinase-myocardial band 65.8 U/l, and amylase 82 U/l. Additionally, many erythrocytes were detected in the full examination of the urine, and the blood culture was positive on the second day (Staphylococcus aureus). The whole abdomen ultrasound examination showed that the echogenicity of both kidneys had increased (grade II). However, bilateral pleural effusion and diffuse fluid in the whole abdomen was shown. Doppler ultrasound was applied bilaterally to the venous and arterial system in the sub-extremities, and evaluated as normal.