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Noticed lump in nostril. Report showed moderate leucocytes. What does that mean?

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Posted on Mon, 10 Jun 2013
Question: Hi,
About three days ago, I found a large bump developing to the left of my left nostril. It slowly became larger and more red and is likely a skin infection. Photos are attached. I am currently being treated with erythromycin at two tablets twice per day. I have also put some muciprocin ointment on it.
My lymph nodes on the left still appear enlarged after having taken the first dose of antibiotics about 18 hours ago, as well as applying the ointment at that time. The node behind and below the jawbone seems smaller, touching this node I can feel my pulse. The node shielded by the jawbone appears larger. I am not sure what these changes in size indicate. In the past, I have had an abscess drained on my face and tested for bacteria, the report stated the following:
GRAM STAIN Moderate leucocytes
Numerous gram negative bacilli
CULTURE Moderate growth of Mixed coliforms

Ulcers and wounds are often colonised by enteric flora. Significance of culture result should be determined clinically.

Staphylococcus aureus or Streptococci NOT isolated.

I have a feeling that the organism involved now could be similar. Would this change the treatment as some antibiotics are not as effective against gram negative bacteria?
doctor
Answered by Dr. Ilyas Patel (39 hours later)
Hello XXXXXXX

Thanks for your query.

I appreciate your descriptions and sending photographs.

I saw your lesion's photos.

It seems that you are having GRANULOMA FACIALE.

However, it should be confirmed by biopsy.

Previous abscess you had seems unrelated with this disease.

Many times it is confused with lupus vulgaris, lupus erythematosus, Sweet syndrome, lymphocytoma cutis, sarcoidosis..Etc.

Blood testing, mantoux test and urine test should be done to rule out above diseases.
So you consult dermatologist for perfect diagnosis and treatment.

Dapsone, antimalarials, steroids, topical tacrolimus may be tried.

Surgery, electrosurgery, cryosurgery, laser are other options.

I hope you might be satisfied with my answer.

Still, if you have any query, you are welcome.

Regards and wishing fast recovery.

Dr. Ilyas XXXXXXX MD


Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Ilyas Patel (3 hours later)
Thanks Dr. XXXXXXX

I have updated photos at the following link and my doctor still thinks it's a skin infection:

WWW.WWWW.WW
Would you agree based on these updated photos? What would be the best course of treatment as I have put on bactroban on the bump and taken e-mycin antibiotics so far.


Thanks,
Regards
doctor
Answered by Dr. Ilyas Patel (3 hours later)
Hi XXXXXXX
I saw video clip of your lesion.
You could take a 2-week course of strong antibiotic with anti-inflammatory drugs.
If it subsides, well and good.
If not subside, it may not be simple infection.
You discuss with your dermatologist and go for further treatment.
As discussed previously.
Thanks.

Dr.Ilyas XXXXXXX MD

Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Ilyas Patel (2 hours later)
Thanks Dr. Illyas,

I will do so, is Keflex (currently taking now) a good option? What type of anti-inflammatory would help in this case?



Regards.
doctor
Answered by Dr. Ilyas Patel (1 hour later)
Hi,

Yes, keflex is a good option.

Antiinflammatory like Ibuprofen and acetaminophen would be helpful to you.

If no result, then diagnosis should be revised.

Thanks

Dr. Ilyas Patel MD

Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Ilyas Patel (6 hours later)
Dear Dr. XXXXXXX

I hope you will allow my final questions. What do you think is most likely causing the problem and if it is not a simple infection, are there other conditions which can cause the lymph nodes under the jawbone and near them to enlarge?


Thankyou.
doctor
Answered by Dr. Ilyas Patel (48 minutes later)
Hi, XXXXXXX

Release your worries.

You just consult any competent dermatologist for perfect diagnosis and treatment.

There are so many causes of lymphadenopathy.

In your case , it may be old infection induced lymphnode enlargement.

I hope you must be satisfied with my answer.

Regards,

Dr. Ilyas Patel MD

Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Noticed lump in nostril. Report showed moderate leucocytes. What does that mean?

Hello XXXXXXX

Thanks for your query.

I appreciate your descriptions and sending photographs.

I saw your lesion's photos.

It seems that you are having GRANULOMA FACIALE.

However, it should be confirmed by biopsy.

Previous abscess you had seems unrelated with this disease.

Many times it is confused with lupus vulgaris, lupus erythematosus, Sweet syndrome, lymphocytoma cutis, sarcoidosis..Etc.

Blood testing, mantoux test and urine test should be done to rule out above diseases.
So you consult dermatologist for perfect diagnosis and treatment.

Dapsone, antimalarials, steroids, topical tacrolimus may be tried.

Surgery, electrosurgery, cryosurgery, laser are other options.

I hope you might be satisfied with my answer.

Still, if you have any query, you are welcome.

Regards and wishing fast recovery.

Dr. Ilyas XXXXXXX MD