Painful lesions On leg

65 year Old male with painful lesions 
On legs

January 10,2022

A 65 year old Male  Came to opd with the chief complains of Painful wounds on Right leg for 25 days.

History of Present Illness
He works as a  tailor at Nalgonda, he is alcoholic, he has been consuming 90-180ml of whiskey every 3 days in a week.

Patient is apparently asymptomatic 3 years  back then he started experiencing lower back pain radiating to bilateral thighs. He says he used to experience tingling and numbness in both his lower limbs for which he went to a local doctor and was diagnosed with L4-L5, L5-S1 disc prolapse and he underwent L5 laminectomy + 
 L4 L5, L5 S1 discectomy.  
But following the surgery   he was unable to wear footwear.
1year After the Surgery he started experiencing difficulty in urination and tremors in both the hands.

2 months back- he  gradually developed swelling of his  bilateral lower limbs followed by Facial puffiness and swelling of his upper limbs. When he went to a local hospital . He was treated there for 12 days and edema decreased and was sent home.But he  Started having SOB (NYHA-4) visited another hospital again and he was treated for 1week then his dyspnea subsided.

During these 2 months he also was diagnosed to be a diabetic and was started on Tab Metformin 500mg twice daily.


25 days back he developed these painful lesions  associated with swelling which started in the ankle and then extended upto the knees for which he went to Govt Hospital.There is a history of discharge from the lesions.After applying the medication lesions have resolved in left leg and swelling also resolved in that leg

Examination
Ulcers were tender and pigmentation seen around ankle.There is decreased Temperature  on the right leg below the knee compared to other leg.
There is decreased Sensation in the legs.


But The right leg still has the lesions,and swelling is also present.Then He came to our Hospital.
CVS Examination :
His apex beat is in the left of the MCL.
S1,S2+ 
CNS -Normal.
Respiratory BAE present.No crepitations.
Lungs - clear on auscultation.
Abdominal Examination -Bowel Sounds Heard.
Provisional Diagnosis : 
Diabetic dermopathy
Diabetic Neuropathy.
Treatment 
Fusidic acid Cream bd for 1week morning and night.
levocetrizine
metformin
paracetamol

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