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Rashless and Bilateral Symmetrical Lower Limb Gangrene in a Patient with Meningococcal Meningitis

September 10, 2018/in Volume 4 | Issue 2 | Sep-Dec 2018

Vol 4 | Issue 2 | Sept-Dec 2018 | page: 14-16 | Ajiboye Lo, Oboirien M, Galadima AB doi- 10.13107/ti.2018.v04i02.070 Author: Ajiboye Lo [1], Oboirien M [2], Galadima AB [1]. [1] Department of Orthopaedic Surgeon, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. [2] Department of Usmanu Danfodiyo University Address of Correspondence Dr. Ajiboye LO, Consultant Orthopaedic […]

Open bilateral tibial shaft fracture: Case Report

September 10, 2018/in Volume 4 | Issue 2 | Sep-Dec 2018

Vol 4 | Issue 2 | Sept-Dec 2018 | page: 26-27 | Marta Santos Silva, Tiago Barbosa, Ana Ribau, Jose Muras. doi- 10.13107/ti.2018.v04i02.073 Author: Marta Santos Silva [1], Tiago Barbosa [1], Ana Ribau [1], José Muras [1]. [1] Centro Hospitalar do Porto – Hospital Santo António, MD, Largo do Prof. Abel Salazar, 4099-001 Porto. Address of […]

Rashless and Bilateral Symmetrical Lower Limb Gangrene in a Patient with Meningococcal Meningitis

September 10, 2018/in Volume 4 | Issue 2 | Sep-Dec 2018

Open bilateral tibial shaft fracture: Case Report

September 10, 2018/in Volume 4 | Issue 2 | Sep-Dec 2018

Full Sized Blog Element (Big Preview Pic)

Rashless and Bilateral Symmetrical Lower Limb Gangrene in a Patient with Meningococcal Meningitis

September 10, 2018/in Volume 4 | Issue 2 | Sep-Dec 2018

Vol 4 | Issue 2 | Sept-Dec 2018 | page: 14-16 | Ajiboye Lo, Oboirien M, Galadima AB

doi- 10.13107/ti.2018.v04i02.070

Author: Ajiboye Lo [1], Oboirien M [2], Galadima AB [1].

[1] Department of Orthopaedic Surgeon, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.

[2] Department of Usmanu Danfodiyo University

Address of Correspondence

Dr. Ajiboye LO,

Consultant Orthopaedic Surgeon,

UsmanuDanfodiyo University Teaching Hospital, Sokoto, Nigeria.

E-mail: ajiboyelo@yahoo.com

Abstract

Introduction: An atypical presentation of meningococcal meningitis in a 10-year-old boy with rashless and bilateral symmetrical lower limb gangrene reported to stress the unusual pattern of the presentation. Unusual presentation of meningococcal meningitis is scarce in the literature, and we are not aware any unusual presentation in our setting.

Case Report: A 10-year-old boy presented with bilateral lower limb gangrene following a week history of high-grade fever, chills, rigors, neck pain and stiffness, convulsions, headache, altered sensorium, anorexia, and vomiting with no associated history of skin rash. Examination revealed an acutely ill-looking boy that was febrile, pale, anicteric, cyanosed, and not dehydrated. The pulse rate was 120/min, blood pressure 90/50 mmHg, a respiratory rate of 26 cycles/min, and symmetrical bilateral lower limb dry gangrene up to midlegs with multiple patchy areas of skin necrosis/dermatitis (with eschars) up to mid-thigh noted with Glasgow coma scale of 12 (E3V4M5) and positive signs of meningeal irritations. The complete blood counts, erthyrocyte sedimentation rate, random blood sugar, and creatinine were deranged while cerebrospinal fluid from lumbar puncture showed features of bacterial meningitis. The diagnosis of meningococcal meningitis with bilateral dry gangrene of both feet and leg was made and was managed with fluid and blood resuscitation, intravenous antibiotics, bilateral above knee amputation, and other supportive care. The treatment and recovery were satisfactory.

Conclusion: Meningococcal meningitis may present in an atypical manner which may pose a diagnostic dilemma and delayed appropriate treatment.

Keywords: Rashless, Symmetrical lower limb gangrene, Meningococcal meningitis.

References

1. Rouphael NG, Stephens DS. Neisseria meningitidis: Biology, Microbiology, and Epidemiology, in Neisseria meningitidis. New York: Springer; 2012. p. 1-20.

2. Sáez-Llorens X, McCracken GH Jr. Bacterial meningitis in children. Lancet 2003;361:2139-48.

3. Marc LaForce F, Ravenscroft N, Djingarey M, Viviani S. Epidemic meningitis due to group A Neisseria meningitidis in the african meningitis belt: A persistent problem with an imminent solution. Vaccine 2009;27 Suppl 2:B13-9.

4. Funk A, Uadiale K, Kamau C, Caugant DA, Ango U, Greig J, et al. Sequential outbreaks due to a new strain of Neisseria meningitidis serogroup C in Northern Nigeria, 2013-14.PLoS Curr. 2014 December 29; 6: recurrents.outbreaks

5. Davis MD. Peripheral symmetrical gangrene. In: Mayo Clinic Proceedings. Toronto: Elsevier; 2004.

6. Hussain M, Sharma SR, Rupsi M. Peripheral symmetrical gangrene in meningitis. Ann Indian Acad Neurol 2014;17:140-1.

7. Singh J, Himanshu D, Nim RK, Dinkar A, Gupta KK. Meningitis with digital gangrene in meningococcal infection: An atypical presentation. J Clin Diagn Res 2016;10:OD03-4.

How to Cite this article: Ajiboye Lo, Oboirien M, Galadima AB. Rashless and Bilateral Symmetrical Lower Limb Gangrene in a Patient with Meningococcal Meningitis. Trauma International Sep – Dec 2018;4(2):14-16.

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Open bilateral tibial shaft fracture: Case Report

September 10, 2018/in Volume 4 | Issue 2 | Sep-Dec 2018

Vol 4 | Issue 2 | Sept-Dec 2018 | page: 26-27 | Marta Santos Silva, Tiago Barbosa, Ana Ribau, Jose Muras.

doi- 10.13107/ti.2018.v04i02.073

Author: Marta Santos Silva [1], Tiago Barbosa [1], Ana Ribau [1], José Muras [1].

[1] Centro Hospitalar do Porto – Hospital Santo António, MD, Largo do Prof. Abel Salazar, 4099-001 Porto.

Address of Correspondence

Dr. Marta Santos Silva,

Centro Hospitalar do Porto – Hospital Santo António, MD, Largo do Prof. Abel Salazar, 4099-001 Porto.

E-mail: marta_sss_@hotmail.com

Abstract

Introduction: Leg shaft fractures are common, usually requiring a complex treatment, especially when they are open fractures.

Case Report: This case report describes the presentation, surgical approach, and complications of a 32-year-old man, who suffered a motorcycle accident, resulting in an open bilateral tibial shaft fracture (Type IIIA + Type IIIB Gustilo-Anderson classification) and right calcaneal Sanders Type IV fracture.

Conclusion: The clinical case illustrates the challenging treatment options, with an excellent clinical and radiological outcome.

Keywords: Tibial shaft fracture, Osteosynthesis, Arthrodesis, Pseudoarthrosis.

References

1. Hungria J, Mercadante M. Fratura exposta da diáfise da tíbiatratamento com osteossíntese intramedular após estabilização provisória com fixador externo não transfixante. Ver Bras Ortop 2013;48:482-90.

2. McMahon SE, Little ZE, Smith TO, Trompeter A, Hing CB. The management of segmental tibial shaft fractures: A systematic review. Injury 2016;47:568-73.

3. Papakostidis C, Kanakaris NK, Pretel J, Faour O, Morell DJ, Giannoudis PV, et al. Prevalence of complications of open tibial shaft fractures stratified as per the gustilo-anderson classification. Injury 2011;42:1408-15.

4. Melvin JS, Dombroski DG, Torbert JT, Kovach SJ, Esterhai JL, Mehta S, et al. Open tibial shaft fractures: I. Evaluation and initial wound management. J Am Acad Orthop Surg 2010;18:10-9.

5. Hutchinson AJ, Frampton AE, Bhattacharya R. Operative fixation for complex tibial fractures. Ann R Coll Surg Engl 2012;94:34-8.

6. Märdian S, Giesecke M, Haschke F, Tsitsilonis S, Wildemann B, Schwabe P, et al. Treatment of tibial non-unions – state of the art and future implications. Acta Chir Orthop Traumatol Cech 2016;83:367-74.

7. Melvin JS, Dombroski DG, Torbert JT, Kovach SJ, Esterhai JL, Mehta S, et al. Open tibial shaft fractures: II. Definitive management and limb salvage. J Am Acad Orthop Surg 2010;18:108-17.

How to Cite this article: Silva M S, Barbosa T, Ribau A, Muras J. Open bilateral tibial shaft fracture: Case Report. Trauma International Sep-Dec 2018;4(2):26-17.

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

Rashless and Bilateral Symmetrical Lower Limb Gangrene in a Patient with Meningococcal Meningitis

Open bilateral tibial shaft fracture: Case Report

Rashless and Bilateral Symmetrical Lower Limb Gangrene in a Patient with Meningococcal Meningitis

Open bilateral tibial shaft fracture: Case Report

Full Sized Blog Element (Big Preview Pic)

Rashless and Bilateral Symmetrical Lower Limb Gangrene in a Patient with Meningococcal Meningitis

Author: Ajiboye Lo [1], Oboirien M [2], Galadima AB [1].

Abstract

References

(Abstract Text HTML) (Download PDF)

Open bilateral tibial shaft fracture: Case Report

Author: Marta Santos Silva [1], Tiago Barbosa [1], Ana Ribau [1], José Muras [1].

Abstract

References

(Abstract Text HTML) (Download PDF)

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