Welcome back to Mystery Case Monday! We will be posting a hypothetical case every week to get our pre-health students thinking about various clinical issues and the anatomical/physiological causes that underlie them. Join us in the comments section to share your insights and tentative diagnoses, then check back on Friday to read about the diagnosis and recommended treatments of these cases.
This week's hypothetical patient is a 65-year-old homeless man who was found lying in a park during a particularly cold and snowy week in South Dakota. The woman who brought him to the hospital was unsure how long the man had been lying in the park. The man was unable to bear weight due to pain in his left hip. Upon examination, his oral temperature was found to be 30.5 degrees C and he had a loss of sensation and motor function in his toes. His feet showed obvious skin damage as they were a yellowish color and had a waxy appearance. His physician ordered x-rays of his hip, which later showed that he had a fracture on his pelvis, which was causing his hip pain. The man was not diabetic. The man had a medical history that included a myocardial infarction. The man's fracture was treated with skeletal traction and he was warmed slowly while being given an infusion to help with the cold injuries to his feet. Withing 72 hours, the patient was showing signs of gangrene in his toes and heels. He was started on intravenous antibiotics and samples of the infected areas were collected to be identified by the medical lab science team on-site. Approximately 6 hours after receiving the antibiotics, the patient developed neck stiffness, opisthotonos, and carpopedal spasms.
Thought Questions:
This week's hypothetical patient is a 65-year-old homeless man who was found lying in a park during a particularly cold and snowy week in South Dakota. The woman who brought him to the hospital was unsure how long the man had been lying in the park. The man was unable to bear weight due to pain in his left hip. Upon examination, his oral temperature was found to be 30.5 degrees C and he had a loss of sensation and motor function in his toes. His feet showed obvious skin damage as they were a yellowish color and had a waxy appearance. His physician ordered x-rays of his hip, which later showed that he had a fracture on his pelvis, which was causing his hip pain. The man was not diabetic. The man had a medical history that included a myocardial infarction. The man's fracture was treated with skeletal traction and he was warmed slowly while being given an infusion to help with the cold injuries to his feet. Withing 72 hours, the patient was showing signs of gangrene in his toes and heels. He was started on intravenous antibiotics and samples of the infected areas were collected to be identified by the medical lab science team on-site. Approximately 6 hours after receiving the antibiotics, the patient developed neck stiffness, opisthotonos, and carpopedal spasms.Thought Questions:
What is the most likely diagnosis for this patient?
What is the most likely causative agent that lead to this patient's condition?
This case was based on a report of an actual case that occurred in 1990. A prophylactic treatment that would be commonly administered in cases like this today was not given to this patient. What is that common treatment for this patient's condition?
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