Eye-Foot Syndrome Case History

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  • 1. A touch of athlete’s foot? An uncommon diabetic presentation
  • 2. A brief history Mr GE • 51 year old male PC: Painful swollen left foot HPC: • 2/12 prior to admission, went walking in Amsterdam on cobbles causing bruised feet. • 10/7 prior to admission, noticed that foot was becoming slightly painful and erythematous.
  • 3. • 1/7 prior to admission, presented to Weston S-Mare A+E – Foot swollen and tender, small area of erythema – BM 22 – Admission debated, but patient eventually given oral Pen V and Fluclox and told to attend GP on Monday after weekend. • Following day came down to Torquay! • Foot increasingly tender and swollen -> A+E • On direct questioning: – No polydypsia – Normally polyuric but on frusemide. – Had noticed increased weight loss over previous two years but had been dieting. – Denied any awareness of loss of sensation in feet or neuropathic Sx.
  • 4. PMH: • Hypertension DH: • Atenolol 50mg OD • Enalapril 40mg OD • Frusemide 40mg OD • NKDA FH/SH: • Non smoker • ETOH – up to 20units/week
  • 5. O/E • Pyrexial Temp 38°C • Obese • Chest: NAD • Abdo: NAD • Legs: Swollen discoloured left foot Area of cellulitis over left shin • Fundoscopy showed small micro aneurysms near point of fixation.
  • 6. Bloods: • WCC 15 • HB 17.0 • PLT 173 • Na 131 • K 4.8 • Ur 7.1 • Cr 105 Microbiology: • Glu 22.5 •Group B Streptococci • Ketones Trace •Light growth of anaerobes
  • 7. Management: • IV Antibiotics: – Benzylpenicillin 2.4g QDS – Flucloxacillin 1g QDS – Metronidazole 500mg TDS • Initially on insulin sliding scale but converted to QDS regime on ward • Diabetes Specialist Nurse review • Dietician review • Retinal screening