Cellulitis and abscess of leg except foot Hyposmolality and/or hyponatremia Impetigo Other atopic dermatitis and related conditions
 
Name:  ___                    Unit No:   ___
 
Admission Date:  ___              Discharge Date:   ___
 
Date of Birth:  ___             Sex:   M
 
Service: MEDICINE
 
Allergies: 
Shellfish Derived
 
Attending: ___.
 
Chief Complaint:
leg pain
 
Major Surgical or Invasive Procedure:
none
 
History of Present Illness:
 
___ year old male with severe, diffuse atopic dermatitis and
secondary eczema herpeticum with multiple admissions to ___ due
to severity of disease.  Also with h/o bacteremia ___ skin
lesions seeding spine with subsequent osteomyelitis of lumbar
spine.  He now presented to his PCP today with 1 week of
worsening skin pustules on arms and legs which have since
opened), multiple open wounds and now with right knee
pain/swelling/redness/warmth.  He has soft tissue swelling
proximal medial thigh with substantial
tenderness and right inguinal LAD. 
.
His sx began one week ago when he got off the bus and had 
chills.
Shortly after he developed R leg pain. The next morning he felt
as though his leg had fallen asleep and then had pain radiating
down to the leg to the knee which he describes as ___ pain and
a raw soreness worsened with ambulation. He was not able to go 
to
work all of last week and he rested to see if it would improve
but it stayed the same. He also applied clobetasol cream which
causes the rash to "dry up" with scaling skin. Given that his
rash was not improving he scheduled an appt to see his PCP 
___.
No night sweats or repeat shaking chills except for 1 week ago. 
.
In ER: (Triage Vitals: 99.6 96 115/69 18 100%   with Tmax in Ed 
=
103) 
Meds Given: tylenol/ceftriaxone.
Vancomycin sticker in ED paperwork but not checked off as given
Fluids given: 
Radiology Studies:US 
consults called: none
With abx given in ED the patient reports that his leg feels much
better. 
.
PAIN SCALE: ___ -> ___ with movement in R leg 

 
Past Medical History:
BACK PAIN 
ECZEMA 
FOOD ALLERGIES -> shellfish -> lip swelling
HSV1 
SEASONAL ALLERGIES 
OSTEOMYELITIS

 
Social History:
___
Family History:
His father died of heart disease at ___. His mother has glaucoma

 
Physical Exam:
1. VS T = 98,  P 91, 16, 98% on RA 114/65
GENERAL:  Well appearing pleasant male laying in bed. He is
surrounded by family
Nourishment: good  
Grooming: good  
Mentation: alert, speaking in   
2. Eyes: [] WNL 
 EOMI without nystagmus, Conjunctiva: clear
3. ENT [] WNL
No lip lesions. 
Dry skin with desquamation noted on neck 
4. Cardiovascular [X] WNL
[X] Regular  [] Tachy  [X] S1 [X] S2 [] Systolic Murmur     /6,
Location:
[X] Edema RLE  None [X] Edema LLE None 
RLE inner thigh with area of mild warmth and hyperpigmentation
with swelling. No clear discrete fluctuant areas. Pus unable to
be expressed. Mildly tender with deep palpation. 
2+ DPP b/l
[X] Vascular access  [] Peripheral [] Central site:
5. Respiratory [X]WNL
Integument  [] WNL
RUE with multiple excoriations, scabs, healing wounds with
surrounding xerosis. B/L lower extremities with multiple areas 
of
hyperpigmenation. Discrete swellng present on extensor surface 
of
forearm without warmth nor erythema. 

 
Pertinent Results:
___ 12:40PM BLOOD WBC-25.1*# RBC-4.24* Hgb-12.8* Hct-39.5* 
MCV-93 MCH-30.2 MCHC-32.4 RDW-11.7 Plt ___
___ 07:00AM BLOOD WBC-20.8* RBC-3.62* Hgb-11.6* Hct-33.7* 
MCV-93 MCH-32.1* MCHC-34.5 RDW-12.1 Plt ___
___ 07:00AM BLOOD WBC-17.0* RBC-3.86* Hgb-12.2* Hct-36.9* 
MCV-96 MCH-31.6 MCHC-33.1 RDW-12.1 Plt ___
___ 12:40PM BLOOD Glucose-92 UreaN-19 Creat-1.0 Na-131* 
K-4.9 Cl-93* HCO3-25 AnGap-18
___ 07:00AM BLOOD Glucose-95 UreaN-13 Creat-0.9 Na-136 
K-5.1 Cl-102
___ 07:00AM BLOOD Glucose-100 UreaN-13 Creat-0.9 Na-137 
K-5.2* Cl-103 HCO3-26 AnGap-13
___ 12:57PM BLOOD Lactate-2.2*

___ 3:24 pm SWAB      LEFT LOWER LEG. 

   WOUND CULTURE (Preliminary): 
      STAPH AUREUS COAG +.    MODERATE GROWTH. 

Time Taken Not Noted     Log-In Date/Time: ___ 4:37 pm
      Direct Antigen Test for Herpes Simplex Virus Types 1 & 2

                            **FINAL REPORT ___

   Direct Antigen Test for Herpes Simplex Virus Types 1 & 2 
(Final
      ___: 
      UNINTERPRETABLE DUE TO INADEQUATE SPECIMEN. 
      Refer to culture results for further information. 
      Reported to and read back by ___ ___ 1:08PM. 


   DIRECT ANTIGEN TEST FOR VARICELLA-ZOSTER VIRUS (Final 
___: 
      UNINTERPRETABLE DUE TO INADEQUATE SPECIMEN. 
      Refer to culture results for further information. 

Time Taken Not Noted     Log-In Date/Time: ___ 4:37 pm
      SWAB

   VIRAL CULTURE: R/O HERPES SIMPLEX VIRUS (Pending): 

   VARICELLA-ZOSTER CULTURE (Pending): 

Blood cultures: NGTD, pending

 
Brief Hospital Course:
___ year old male with h/o severe atopic dermatitis requiring 
admissions for it in the past c/b osteomyelitis now presenting 
with rash, leukocytosis and fevers.

# cellulitis: Ultrasound of right lower extremity in the ED was 
negative for abscess or DVT. Symptoms improved with IV 
antibiotics and pt was discharged on clindamycin to complete a 
course of antibiotics.

# Eczema: Started mupirocin and clobetasol per derm recs. They 
would like him to f/u in derm office in ___. They have asked 
their scheduler to call the patient.

 
Discharge Medications:
1. Hydrocortisone Cream 1% 1 Appl TP BID 
RX *hydrocortisone 1 % apply to face twice a day Refills:*2
2. Clobetasol Propionate 0.05% Ointment 1 Appl TP BID 
RX *clobetasol 0.05 % apply to arms and legs twice a day 
Refills:*2
3. Mupirocin Ointment 2% 1 Appl TP BID 
RX *mupirocin 2 % apply to open wounds twice a day Refills:*2
4. Clindamycin 300 mg PO Q8H 
RX *clindamycin HCl 300 mg 1 capsule(s) by mouth every eight (8) 
hours Disp #*21 Capsule Refills:*0

 
Discharge Disposition:
Home
 
Discharge Diagnosis:
Cellulitis
 
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
 
Discharge Instructions:
You were admitted with a skin infection (cellulitis). You were 
treated with antibiotics and your infection improved. You were 
seen by the dermatology doctors. ___ will call you to arrange a 
dermatology follow up appointment in a few months.
 
Followup Instructions:
___

{'leg pain': ['Cellulitis and abscess of leg', 'except foot'], 'chills': ['Cellulitis and abscess of leg', 'except foot'], 'skin pustules': ['Cellulitis and abscess of leg', 'except foot', 'Impetigo'], 'open wounds': ['Cellulitis and abscess of leg', 'except foot', 'Impetigo'], 'right knee pain/swelling/redness/warmth': ['Cellulitis and abscess of leg', 'except foot'], 'soft tissue swelling': ['Cellulitis and abscess of leg', 'except foot'], 'tenderness': ['Cellulitis and abscess of leg', 'except foot'], 'eczema': ['Other atopic dermatitis and related conditions'], 'bacteremia': ['Other atopic dermatitis and related conditions'], 'osteomyelitis': ['Other atopic dermatitis and related conditions']}