HPI: The patient is a 94 yo man in fair general health. Hi has chronic pruritus of "Willan's Itch" and has been on prednisone 10 mg daily for a year to control his intractable pruritus. He sits for hours per day because of a tendon tear around the left knee that severely restricts ambulation. His mental status is fair. He has no marked dementia, but has slowed down in the past couple of years. Other than orthopedic problems he has no serious medical disorders.
O/E: Red, tender mass in the left buttock.
Photo:
Lab: Culture taken from crusted area grew moderate Saph aureus sensitive to everything except penicillin
Procedure: The patient was sent to a surgeon who did and I and D and packed the area. He reported ~ 40 cc of pus admixed with blood.
At present the patient is home, fairly comfortable, on cephalexin 500 mg tid. Packing is changed daily.
Diagnosis: Gluteal abscess.
Questions: This is a somewhat frail 94 yo man. He does not want to enter hospital. I am concerned that there may be loculations that have not been probed. Considering the organism, is cephalexin enough?
I would normally admit such patients to the ward. Otherwise I think he needs a I & D again to drain the pus that has accumulated. I think proper dressing is important for prompt recovery. you can try hydrogen peroxide (1:2 dilution) to clean up the wound. If the organism is Staph aureus, try flucloxacillin 500mg qid. My favourite is cefuroxime 500mg bd though. Check blood sugar to rule out underlying diabetes mellitus that may have aggravated the condition. I think he should do well.
ReplyDeletePerhaps we can also consider another culture from the drainage itself.
ReplyDelete