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Atraumatic presentation of compartment syndrome with post-intervention systemic inflammatory response and complex regional pain syndrome: A case report

Shields, J; Patel, S; Gambhir, N; Alben, M; Lucido, J V
Background/Purpose: Compartment syndrome is a well-known surgical emergency within the scope of Podiatry. However, cases can be atraumatic and present without the traditional findings of pain, pallor, paresthesia, pulselessness, paralysis, and poikilothermia. Thus, posing a diagnostic dilemma for clinicians, leading to delayed surgical intervention and poor outcomes. We report a rare case of acute exertional compartment syndrome and include a discussion on current literature to increase awareness of atypical presentations of compartment syndrome. Methods/Results: A 27-year-old healthy female with no significant past medical history was treated for intractable right foot pain following an extended period of marching. Physical examination was remarkable for non-palpable pedal pulses, pain out of proportion, extensive soft tissue edema, and a warm-to-cold temperature gradient of the extremity. The diagnosis of compartment syndrome was confirmed via catheter evaluation of compartmental pressures. Emergent fasciotomy of the right foot was performed, and delayed primary closure was performed six days later. After discharge from the hospital, the patient was inconsistent in follow up visits. Later repeat imaging of the right foot revealed stress fractures and nondisplaced fractures throughout the tarsometatarsal region. At her most recent visit, the patient complained of persistent paresthesias, skin discoloration, and pain to the right foot for which she is receiving symptomatic management for.
Conclusion(s): Diagnosis in this patient was likely delayed due to strict adherence to a post-traumatic model of compartment syndrome. Broadening awareness to the variable presentations of compartment syndrome is an important step to improve patient outcomes.
ISSN: 2667-3967
CID: 5512102

Insights for the Growth of Stenotrophomonas maltophilia in a Diabetic Patient with Long-Term Antibiotic Use: A Case Study

Huchital, Michael J; Kim, Jason; Mantzoukas, Argirios; Lucido, Jeffrey V
BACKGROUND:Stenotrophomonas maltophilia is an uncommon gram-negative bacterium often found in individuals with long-standing broad-spectrum antibiotic use or catheter use; individuals undergoing hemodialysis; and individuals with prolonged respiratory disease, specifically, cystic fibrosis. To our knowledge, there are few reported cases of S maltophilia being the causative pathogen of infection in a diabetic foot wound. METHODS:Following multiple surgical procedures and deep tissue cultures, S maltophilia was determined to be a secondary opportunistic colonizer of the wound, necessitating a change in antibiotic therapy. RESULTS:The cultured pathogen was sensitive to ceftazidime, levofloxacin, and trimethoprim-sulfamethoxazole. The treatment team chose to use ceftazidime, as it also provided antibiotic coverage for the initial wound and blood cultures. Change in antibiotic therapy was initiated following multiple surgical procedures and angioplasty of the lower limb. The patient was discharged with a peripheral intravenous central catheter for outpatient antibiotic therapy. CONCLUSIONS:Prolonged exposure to broad-spectrum antibiotics in individuals with multiple comorbidities including diabetes mellitus provides an advantageous environment for growth of uncommon multidrug-resistant organisms. Stenotrophomonas maltophilia may complicate the treatment of diabetic foot infections as an opportunistic pathogen. Understanding the implication of long-term broad-spectrum antibiotic treatment in the diabetic patient is important in managing postoperative complications and determining the correct course of treatment. The emergence of atypical pathogens in diabetic wounds must be managed appropriately.
PMID: 33179060
ISSN: 1930-8264
CID: 4665372

Utilization of bone scan and single photon emission computed tomography on amputation planning in acute microvascular injury: Two cases

Huchital, Michael; Au, Andrew; Lucido, Jeffrey V
The use of single photon emission computer tomography (SPECT/CT) in acute vascular injury is not well documented. SPECT/CT combines the anatomic detail of computer tomography with the functional vascular perfusion of photon emission to determine the viability of osseous structures and surrounding soft tissue. The superimposed imaging provides the practitioner with a reliable anatomic image of viability of a specific anatomic area following insult or injury. We present two cases, bilateral lower extremity frostbite, and symmetric peripheral gangrene in which this imaging modality provided guidance for surgical intervention with adequate predictability and results.
PMID: 31675679
ISSN: 1532-2963
CID: 4162842

Chondroid Syringoma of the Foot: A Rare Diagnosis

Madi, Khaled; Attanasio, Alicia; Cecunjanin, Fejzo; Garcia, Roberto A; Vidershayn, Alexander; Lucido, Jeffrey V
Chondroid syringoma is a rare tumor with the potential for malignant transformation and distant metastasis. The site of predilection for benign chondroid syringoma is the head and neck region, and it is less likely to involve the foot. In contrast, malignant chondroid syringoma is more commonly encountered in the extremities and is characterized by rapid growth, local invasion, and distant metastasis. We report an unusual case of benign chondroid syringoma in a 47-year-old female who presented with a 20-year history of a mass in her left foot to bring such cases to the attention of foot and ankle specialists. We highlight the histologic diagnosis and surgical procedures with a 6-month postoperative follow-up period. It is unlikely that a treating physician would anticipate this histologic tumor type, considering the rarity of the condition, the long history of this patient's lesion, and the benign presentation in the extremities.
PMID: 26015300
ISSN: 1542-2224
CID: 1808552