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Had fem-fem bypass re-do and sepsis. Was on IV and oral antibiotic.Taking rifampin. Developed petichiae in affected leg. Related?

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Let me start off, I am a CCRN with 35 yrs experience. I had a fem-fem bypass re-do Feb 8. Feb 25 I was re-admitted with sepsis. Both wounds were infected as well as Methicillin sensitive ( thank heavens) staph. I was on IV and oral antibiotics and am still on oral Rifampin and Duricef. Over the course of the last week to 10 days, I have developed petichiae in my affected (left) leg and on my right wrist. My left ankle is so painful I can barely walk without analgesia ( APAP, ASA and ibuprofen). There is only slight swelling at the ankle and wrist. Yesterday I started Naproxen. I cannot get into my regular MD for another 4 weeks. Do you think there is a connection? I am 52 yr, male, relatively fit and healthy other than the PAD.
Posted Sat, 18 May 2013 in Infections
Answered by Dr. Prasad Akole 1 hour later
Dear friend, welcome to Healthcaremagic!
I am Dr. Prasad Akole (Critical Care Expert- and am glad to address to your query here.

I am a bit concerned as your femoro-femoral arterial bypass wounds are infected and now you have petechae on the right wrist which is unrelated to the site.
Pain, petechae, swelling at the left ankle can be expected to be secondary to the bypass related problems.
I see 2-3 possibilities.
1.     Deranged coagulation due to blood thinners (if you are on), ASA, NSAIDs or due to sepsis – this explains wrist affection.
2.     Septic distal embolization and cutaneous ischaemia from any graft clots.
3.     Medicines related platelet dysfunction (as WBC is Ok you say)- you are on ASA, NSAIDs

Could you check and tell if you have any arterial ischaemia at the ankle (check pulse, coldness, pallor, pain, tenderness) and wrist.
Since you unable to XXXXXXX your regular MD now, I would advise to keep these possibilities in mind and check for coagulation status-both under and over- anticoagulation can cause problems.
Sepsis also can derange coagulation.

I would advise you to go to ER if you get any worsening of pain at ankle or ecchymoses.

I hope to have answered your query satisfactorily. I would be glad to answer any further queries. Take care and please keep me informed of your progress at
Good Luck!
Above answer was peer-reviewed by
Follow-up: Had fem-fem bypass re-do and sepsis. Was on IV and oral antibiotic.Taking rifampin. Developed petichiae in affected leg. Related? 1 hour later
Thank you for taking the time to review my symptoms. I appreciate your time and expertise.

The left foot has a very weak pulse and is slightly dusky, although no more than when I was discharged after 10 days of treatment for the septic infection.
The pain in that ankle is immobilizing at times. Analgesia takes 30 to 45 minutes to work well enough that I can ambulate. I don't notice any change other than the swelling and pain.

The right wrist is more of a constant, dull ache. There is a minimal amount of swelling in the fingers and doral aspect of the hand and ends just above the wrist.
I did notice some petchiae in the left leg today ( when showering) that was not there yesterday. ( I bathed while you were answering)
I am on Plavix 75mg daily as well as the routine ASA 325 mg.
As an aside, I am on hycosamine and immodium routinely post a double SB resection 4 years ago when surgeons attempted a aorto-fem bypass and I developed a SBO. That graft failed at 4 yrs leading to the need for the fem-fem bypass.

Needless to say, I am weary of both surgery and being ill.
Answered by Dr. Prasad Akole 1 hour later
Thanks for the update.
My advice remains the same.
Since you are on dual anti-platelets, you are likely to have petechae.
Keep a watch on rapid increase and left foot colour, coldness, pallor indicating loss of pulsations.

I hope right wrist is not dusky and colder.are finger and toe movements normal?
I wish you get better soon. Good luck !!

Above answer was peer-reviewed by
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