A 38-year-old male allergic to Penicillin, an 80 gram alcohol drinker/day and an obese patient came to the Emergency Department of our Hospital because of a clinical picture of edematous plaque in the lower extremities,
The patient also presented significant asthenia of several weeks duration accompanied by nausea, vomiting and diarrhea in the last 7 days.
Physical examination revealed the presence of 37.5oC temperature, abdominal ascites and edema in both lower extremities, especially in the right limb, associated with erythema, petechiae and ecchymosis.
No other pathological data were observed.
At admission, the following results were obtained: hemoglobin 8.3 IU/dl; hematocrit 9.23.3%; leukocytes 20.420 per μdl (neutrophil 119 μg/dl; creatinine 119 μdl; platelets 91.5%)
A chest X-ray was normal and an abdominal ultrasound and CT scan showed massive ascites, chronic liver disease and enlarged spleen.
With the clinical judgment of acute renal failure, in the context of a chronic liver disease of enolic origin and colitis in the lower extremity, he was admitted to the Nephrology Department.
Treatment was initiated with diuretics (Furosemide) and empirical antibiotic therapy with Ciprofloxacin (1gr/ 24 hours) after extraction of blood cultures.
Twenty-four hours after admission, the patient developed fever (38.4o C) and worsening of lower limb lesions (LLL), with increased pain, extension of the right hypersensitivity and presence of blisters.
The laboratory tests showed a worsening in renal function with plasma creatinine values of 10.60 mg/dl and urea 181 mg/dl, an increase in leukocytosis (35.340 per μl, prothrombin time of 66.8 %) and prothromboplastin alterations.
In the hemocultive performed at admission was isolated Streptoco informed Pyogenes, so it was initiated intravenous antibiotic therapy with Clindamicin and Gentamicin mechanical wound up to the last half hours.
1.
It presents an unfavorable evolution with multiorgan failure (acute renal failure, coagulopathy and acute respiratory distress syndrome) not responding to hemodynamic support measures or antibiotic therapy and finally dies at 24h.
