CASE (21/2/07)
22 year old male presents with bilateral pitting pedal edema for the last 4 days. There is no pain or discomfort. Medial malleolus, dorsalis pedis and posterior tibialis were all not palpable.
The swelling is limited to his ankle area, his toes are spared. The only pathology seen on inspection is generalised dryness of the area with signs of recent trauma from scratching, due to chronic eczema.
He has never had such problems before. He doesn't know of anyone in his family having heart problems, liver problems or kidney problems.
Heart rate is within normal limits, BP is normal, S1 and S2 heard with no additional heart sounds or murmurs.
The patient is on antihistamines and topical corticosteroids.
The patient is mainly allergic to dust and seafood.
What is your differential/provisional diagnosis?
(Hint:He is at an unlikely age to suffer from the common causes of such edema.)
PS : Adelaide people are hereby prohibited from providing answers or clues.
ANSWER :
Patient suffered from a combination of vasodilatation due to the excessive heat and increased vascular permeability, most likely from trauma to the skin from excessive scratching of the ankle area. It is possible that a low-grade infection was also present but this was not confirmed.
The doctor advised that the patient didn't need any blood tests but would be happy to do it if the patient wanted.
The patient did not want a blood test and was advised to let time take its course and return if pain develops or he swelling remains after a couple of weeks.
The swelling regressed and disappeared within 4 days of seeing the doctor.
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8 comments:
any history of trauma/bites/stings?
barring all... I come to the drastic conclusion of...
PS2 withdrawal symptom.
:: nods to herself ::
walking too much, inflammation n infection from scratching too much, not taking enough water n vit c....
How long has he had the eczema, and how long has he been on topical steroids? Is the eczema localized around the ankles? And also, what is his weight? Occupation? Does he do anything which might make him stand for long periods of time?
A "pseudo-oedema", perhaps? ....long-term use of topical steroids can cause thinning of the skin. Couple that with long-term standing and being a bit on the heavy side could just as well cause some leg swelling. And the ankle-"oedema" would be even more prominent due to the thin skin....??? o_O
Man, does that make sense? I'm getting confused myself! -_-"
With no medical background, I'm gonna stick with something easy - insufficient intake of fruits & vege. Ie. having vitamin A & C deficiency, perhaps others too. Yeah, probably needs to drink more water too.
KENNN!! i think d history's your's? tho no idea wats up! i shud prolly shut up! hope all's fine! God bless
Haha, well the answer is up and the patient's identity will be kept a secret...confidentiality and all that.
Oh and Iona, PS2 withdrawal symptoms would probably kick in within days not weeks no? Not too sure about that though.
...wonder who anon is?
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