Cast 29 187 CASE The patient was a 61-year-old female textile worker who was in her usual state of good health until she

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Cast 29 187 Case The Patient Was A 61 Year Old Female Textile Worker Who Was In Her Usual State Of Good Health Until She 1 (62.84 KiB) Viewed 17 times

Cast 29 187 CASE The patient was a 61-year-old female textile worker who was in her usual state of good health until she was awakened at 3 a.m. on the day of her hospital admission with severe left upper extremity pain. She was seen in the emergency department, where she denied shortness of breath and chest pain. An elec- trocardiogram (EKG) was normal. Her physical examination was significant for cellulitis of the left upper arm. Her arm was very tender to palpation and had decreased range of motion. There was no history or evidence of trauma to her arm, and no scratches or other lesions were apparent. She did not have axillary or cervical lymphadenopathy. Her cellulitis progressed over the next 2 hours with a new finding of crepitance in the upper left arm. A radiograph of her left gas in the soft tissues. Significant laboratory findings included a white blood cell count of 21,000 with 90% neutrophils and creatine kinase (CK) of 1,554 with a normal heart muscle fraction. She was begun on penicillin and gentamicin and taken to the operating room, where necrotic muscle was found. Gram stain of a biopsy from the left upper arm is shown in Fig. 1. Blood cultures obtained prior to the initiation of antimicrobial agents and the biopsy specimen revealed an organism that grew only under anaerobic incubation con- ditions. Growth on a blood agar plate is seen in Fig. 2. arm revealed 1. What condition does this woman have? Explain her CK findings in light of the infection she has. 2. What is the usual therapy for this type of infection? 3. What is the organism causing this patient's infection? Hint: There is a structure visible within the bacteria seen on tissue section that is an important chce to which organism is likely causing her infection. The colonial morphology in Fig. 2 is typical of this organism as well. 4. Few whites are seen in the tissue section, and often few are seen on Gram of tissue biopsies in patients infected with this p group of organism 5. When the surgeons knew the identity of her organism, they immedi- ately examined her bowel. For what were they looking and why? Figure 1 Figure 2