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A Case of Chronic Osteomyelitis with Trophic Ulcer of FootHomeopathic Journal :: Volume: 1, Issue: 5, Jul-Aug 2008 (General Theme) - from Homeorizon.com
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ABSTRACT-
A 6 yrs. female child was suffering from Swelling of both legs (feet) with ulceration and discharging sinuses since 2yrs was treated successfully by Homoeopathic medicine.
PRESENTING COMPLAINTS-
Swelling of both legs (feet) with ulceration since 2yrs.
Incontinence of urine since birth.
Numbness of both legs since birth.
HISTORY OF PRESENTING COMPLAINTS-
1) Swelling of both feet with ulceration since 2yrs.
Onset- Gradual
Location- initially ulcer developed first on left great toe and then various small Irregular ulcer developed on dorsum of foot also involving sole of feet.
On medication, the ulcer got healed up. Then after due to playing bare foot ulcer developed again on medial side of right sole. On left foot also ulcer again due to rat biting.
Character of ulcer- left leg ulcer-irregular shape, Blood oozes out. No discharge with formation of crusts, when ulcer dries up.
Right leg ulcer- irregular margins, no discharge.
Associated complaints- there is sinus formation below the ulcer on right Sole of foot. Diagnosed as Osteomyelitis
Character of discharge- Pus from sinus, white, watery, sticky and offensive discharge.
Diagnosis given from A.I.I.M.S - Osteomyelitis of right ankle joint with tropical ulcer and discharging sinus. Lipo-meningomyelocoele with neurological deficit left lower limb.
2) Incontinence of urine since birth
Mode of onset- At the time of birth she was diagnosed with spinal cord tumour in the lumbar region at 14yrs of age, which was operated. At 1yr of age her mother noticed incontinence of urination and after operation in 2002 she was diagnosed with neurogenic bladder.
Character of urine- Dribbling of urine with normal stream and scanty sometimes. No burning.
Frequency- D7-8 N0. since last 1yr, she tells about the urge for urination.
Photograph take before the treatment
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PAST HISTORY-
History of memeigomyelocele at 1yr of age (2002)
History of vaccinations- not given
History of X-ray- done.
PERSONAL HISTORY-
Diet- veg
Developmental landmarks- On time
Addictions- Nil
Environment at home- Congenial
PHYSICAL GENERALS-
Thermal reaction- Chilly
Appetite- Normal, 3meals/ day
Thirst- Reduced, 1/2- 1L of water/ day. During fever thirst increased.
Urine- Incontinence of urine, D7-8 N0, no burning, offensive.
Stool- Normal, satisfactory stool. But usually remains constipated.
Desire- Fried, spicy.
Aversion- Sweets
Sleep- Normal
Dreams- N.S
MENTAL GENERALS-
Anger, introvert and reserved. Desire company. Memory- normal.
PREVIOUS TREATMENT & INVESTIGATIONS REPORT-Patient was diagnosed as 'Meningomyelocele in the lower lumbar region' from A.I.I.M.Sl, New Delhi on 19-01-2002. For this she was operated on 24-01-2002.Patient developed neurogenic bowel & bladder since the time of operation. Then patient developed 'Osteomyelitis & Trophic ulcer of the foot' according to the report of A.I.I.M.S on 29-10-2004 which was treated by allopathic medicine since then but no improvement found of the Osteomyelitis & Trophic ulcer of the foot.
INVESTIGATIONS REPORT-
6/02/06
VSG- normal ventricular system
14/02/06
MRI- spine- lipomeningomyelocele in lower lumbar region with thickening of distal cord to the wall of the sac.
10/7/02
USG KUB- normal study
18/07/02
FUC of lumbosacral meningomyelocele- plain X-ray, Lt CDH, shows failure of fusion of posterior process. No VUR, PVR present.
23/07/02
urine test- RBC- 5-10/HPF
WBC- 15-20/HPF
18/02/02
muscles test- ankle, foot and planter flexor; Muscle power- 0
29/10/04
blood test- Hb- 4.7gm/dl
HCT- 17%
RBC- 2.46x 10
Platelet count- 476
MCV- 69ft
MCH- 19pg
MCHC- 28gm/dl
29/10/04
blood biochemistry- urea- 25gm%
Cr- 0.4mg%
Total protein- 6.7gm%
Albumin- 2.9gm%
Globulin- 3.8gm%
SGOT- 35IU
SGPT- 14IU
Alkaline phosphate- 112IU
18/02/05
urine test- RBC- 4-6/HPF, 40-50/HPI
calcium oxalate crystals- +
28/02/05
USG(KUB)- significant PUR
28/02/05
filling cystometry- cystometric capacity- 89ml
static complain- 2ml/cm H2O
5/03/05
MCV- trabeculated outline of bladder with significant PUR.
05-09-2006
Routine haemogram on 05-09-2006 shows there is microcytic hypochromic anaemia.
SYSTEMIC EXAMINATION-
CENTRAL NERVOUS SYSTEM-
Higher functions
Consciousness- fully conscious.
Intelligence- good.
Memory- intact both recent and past.
Behaviour- normal.
Speech- normal.
Orientation- normal.
Cranial nerve examination
All 12 cranial nerves- normal.
Motor cranial nerve
Tone- normal in upper limbs. knees, ankle - reduced.
Power- U/L- normal
L/L- ankle joint reduced,
Sensory system
Superficial sensation
Touch- absent in left lower limb below knee.
Pain- upper limb present, below knees absent.
Deep sensation-Normal
Reflexes
Superficial- abdominal reflex increased.
Deep tendon reflexes- normal
SPINAL EXAMINATION
Inspection
Scar marks can be seen on spine.
Palpation
No pain
PRESCRIPTION-
5.09.06
11.00pm
fever- 103.4o F
P.R- 162/min
RX
Bell 200/4, fractional doses
6.09.06
D/R- all complaints same but fever better.
PG's
Appetite- Normal
Thirst- Small quantities frequently, mouth dry.
Stool- Normal, constipated sometimes.
Urine- Incontinence.
Sleep- Normal.
Tongue- White coated thickly.
Thermal reaction- Chilly patient
Desire- Salty, fried.
P.R- 92/min
R.R- 18/min.
Rx
Silicea 0/1, B.D for 2days
Dressing with calendula.
8/09/06
GCs- same
Fever-102.40 F
Rx
Silicea 0/1, B.D for 2days
10/09/06
P.R- 116/min
R.R- 26/min
Rx
Silicea 0/1, BD, 1day
11/09/06
fever- 1010 F
PR- 74/min
RR- 20/min
Rx
Silicea 0/3, BD, 1day
12/09/06
PR- 92/min
RR- 22/min
13/09/06
PR- 76/min
RR- 18/min
Rx
Silicea 0/3, OD, 1day
14/09/06
PR- 80/min
RR- 14/min
Rx
Silicea 0/3, OD, 1day
15/09/06
GCs better
PR- 100/min
RR- 20/min
Rx
Silicea 0/3, OD, 1day
16/09/06
PR- 105/min
RR- 24/min
Rx
Silicea 0/3, OD, 1day
18/09/06
PR- 110/min
RR- 25/min
Rx
Silicea 0/3, OD, 1day
19/09/06
PR- 78/min
RR- 18/min
Rx
Silicea 0/3, OD, 1day
20/09/06
PR- 120/min
RR- 28/min
Rx
Silicea 0/3, OD, 1day
21/09/06
PR- 90/min
RR- 28/min
Rx
Silicea 0/3, OD, 1day
22/09/06
PR- 120/min
RR- 26/min
Rx
Silicea 0/3, OD, 1day
23/09/06
fever- 1030 F
PR- 102/min
RR- 24/min
Rx
Silicea 0/5, OD, 2days
24/09/06
fever- 98.40 F
PR- 80/min
RR- 22/min
Area around the ulcer was bruised.
25/09/06
fever- 1000 F
PR- 100/min
RR- 25/min
Dirty thick yellowish discharge from scar.
Rx
Silicea 0/5, OD, 2days
26/09/06
PR- 92/min
RR- 20/min
Ulcer discharging profuse, thick, light yellow.
27/09/06
fever- 1000 F
PR- 120/min
RR- 20/min
Rx
Pyrogen 200/1dose
28/09/06
PR- 92/min
RR- 24/min
29/09/06
fever- 100.60 F
PR- 118/min
RR- 22/min
30/09/06
PR- 120/min
RR- 22/min
1/10/06
fever- 1050 F
PR- 102/min
RR- 22/min
Rx
Bell 30/1dose (stat)
3/10/06
fever- 1040 F (8.30pm)
R- 126/min
RR- 30/min
Rx
Pyrogen 200/1dose
4/10/06
fever- 1000 F
PR- 82/min
RR- 20/min
RX Placebo for 5days
9/10/06
fever- 990 F
PR- 80/min
RR- 20/min
RX Placebo for 5days
14/10/06
Total healing of foot ulcer with no discharge from sinuses.
fever- 98.50 F, PR- 75/min
RR- 18/min
RX Placebo for 5days
Photograph take After the treatment
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THERE WAS COMPLETE HEALING OF TROPHIC ULCER OF FOOT WITH LEAST SWELLING AND NO DISCHARGING SINUSES
COMMENTS-
Patient's osteomyelitis of bone and trophic ulcer of foot improved very nicely by homoeopathic medicine but no improvement regarding her neurogenic bowels & bladder was obtained.
SILICEA was prescribed on the basis that, patient was chilly & the particular sphere of action on caries of bone. If we see the Kent's Repertory we will see that Silicea is a medicine that covers the rubric 'CARIES OF BONE' as well as all sub rubrics. In caries of bone-foot, Silicea is the only medicine that covers in 2nd grade.
PYROGEN was prescribed on the basis of recurrent fever with septic condition from osteomyelitis and tropic ulcer of foot.
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