New Orleans Citywide Rounds
A Physician With Osteomyelitis
from Infections in Medicine ® 2001
Melissa Wynn, MD, Richard J. Wallace, Jr, MD, Katherine Baumgarten, MD, and Julia Garcia Diaz, MD,
A 51-year-old male physician, previously healthy, was admitted for evaluation and treatment of an infected wrist.
Initially, a papule had developed on his right index finger 17 months before admission. At that time, he stated that he frequently obtained minor lacerations while hunting and fishing in the marshes. He lanced the papule, but it did not heal; subsequently, it became violaceous and edematous. He self-medicated with cephalexin, 1g tid, for approximate-ly 2 weeks and followed this with doxycycline, 100 mg/d, for 4 weeks but noted no improvement.
Necrotizing Fasciitis of the Upper Extremity Resulting From a Water Moccasin Bite
from Southern Medical Journal
Michael F. Angel, MD, Feng Zhang, MD, PhD, Matthew Jones, BS, James Henderson, MD, Stanley W. Chapman, MD
Abstract and Introduction
Aeromonas hydrophila infection has been described as the cause of necrotizing fasciitis in patients with suppressed immune systems, burns, or trauma in an aquatic setting. We report a case in which severe necrotizing fasciitis involving hand, arm, chest, and lateral side of trunk, along with toxic shock, developed after the patient was bitten by a venomous snake. Mixed aerobic and anaerobic bacteria, including A hydrophila, were isolated from the wound culture. The patient was treated with antivenom, a diuretic regimen, broad spectrum antibiotics, and 18 separate surgical procedures. After the application of skin grafts, the wound completely healed. This case illustrates that a venomous snakebite may result in infection with A hydrophila and can cause severe necrotizing fasciitis. Early and aggressive surgical intervention should be implemented as soon as the necrotizing fasciitis is diagnosed.
7 y.o. boy with ulnar clubhand II type (Swanson)-right.
Radial head dislocation.
Elbow movements - flexion 150 , extension -10 , rotation 70
Wrist movements - flexion 80 , extension 85 , ulnar deviation 40 , radial deviation 10.
Hand function - can grasp large and small objects , can write.
Hypoplasia of the humeral bone.
Aplasia of the V digit.