case_images: PMC10984238_01
case_images: Left calf of a IDU patient: evidence of swelling and ecchymosis in the site of cocaine injection; hyperpigmentation and chronic scarring (skin popping scars) in the distal leg area.
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case_images: The left calf clinically appeared with moderate erythema, localized swelling (from the proximal 1/3 to the distal 1/3 of the calf) and hard (positive 'wooden hard feel' sign) with a small ecchymosis area (Figure 1) in the site of injection. At homolateral distal extremity, there was evidence of drug induced scarring (skin popping; Figure 1).
case_images: CT scan of the left leg (sagittal scans): evidence of large subfascial abscess (a) and multiple air bubbles in the sub- and supra-fascial soft tissues (b).
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case_images: Computed tomography (CT) scan showed a large subfascial abscess in the posterior region of the leg (axial diameter of 3.5 cm x 7.2 cm and longitudinal extension of 10.4 cm), associated with multiple air bubbles in the adjacent supra-fascial soft tissues down to the skin plane (Figure 2(a,b)).
case_images: Culture on anaerobic medium (schaedler agar) from intraoperative specimens collected during fasciotomy of the leg.
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case_images: However, culture for anaerobic microorganisms (Schadler agar; Figure 3) resulted positive after 5 days of incubation in an oxygen-free environment at 35 C, with growth of Gram-negative bacilli (Figure 4).
case_images: Growth of Gram-negative bacilli on anaerobic medium from intraoperative specimens collected during fasciotomy of the leg.
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case_images: However, culture for anaerobic microorganisms (Schadler agar; Figure 3) resulted positive after 5 days of incubation in an oxygen-free environment at 35 C, with growth of Gram-negative bacilli (Figure 4).
case_images: Orthopantomography of the IDU patient: signs of periodontal disease, with a thin periodontal pocket at the implantation of a tooth element.
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case_images: As P. denticola is a commensal of the oral cavity, an orthopantomography was performed and it showed signs of periodontal disease, with a thin periodontal pocket at the implantation of a tooth element (Figure 5).