A 41-year-old patient came to the emergency department complaining of progressive swelling and pain in the external surface of the left thigh for 4 days after physical exercise on a static bicycle.
He was diagnosed with a hematoma in the vastus externa of the quadriceps and treated with compression bandage, local cold application and oral NSAI medication.
Forty-eight hours later the patient returned to the emergency department complaining of progression of inflammation and pain in the thigh.
She hasn't had a fever.
The patient had insulin-dependent diabetes mellitus for 8 years.
He also reported having suffered a puncture wound at the age of 16 in the affected area.
In the physical examination inflammation, redness and increased local temperature of the lateral face of the left thigh are observed with a skin bulging in an approximate area of 20 x 10 cm and a slight fluctuation in the distal part.
Knee mobility is very limited by pain.
1.
Blood count showed leukocytes of 11.4 x 103/mm3, 89% neutrophils and 3% fell.
Fibrinogen is 1139 mg/dL and ESR 69 mm/ 1 hour.
Blood glucose is 329 mg/dL.
Plain X-rays show the image of a beggar lodged in the distal third of the thigh, about 3 cm from the lateral cortex of the tape
1.
With the provisional diagnosis of intramuscular abscess of the vastus externalis, it was decided to perform surgical drainage.
Two limited incisions are performed on the lateral aspect of the thigh through which purulent secretion lata evacuates abundantly.
Intramuscular communication was found between both incisions leaving two Penrose drains along the lesion after exhaustive lavage.
1.
Gram stain of the evacuated material showed abundant Gram positive cocci, so intravenous antibiotic treatment with amoxicillin/clavulamic acid 2 grams every 8 hours was instituted.
After 48 hours Streptococcus intermedius was isolated in the culture of three different samples of the dried material, maintaining the same antibiotic treatment.
The evolution was favorable, with a clear improvement of pain in the first 24 hours.
After 48 hours, the patient was discharged and on the 6th postoperative day he was able to manage without help.
ESR, fibrinogen and CRP values decreased progressively until completely normalized at week 4.
The same antibiotic treatment was maintained during the 4 weeks of hospitalization, adding 15 days more amoxicillin/clavulanic acid 875/125 mg orally.
The patient required a short period of rehabilitation treatment that allowed him to recover complete knee flexion at the end of the 6 week after surgery.
In the reviews performed at one month, three months and one year, the patient remained asymptomatic and with complete functional recovery.
