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Recurrent Abscess On Buttock, Had Surgically Drained. Wound Not Healing. Diabetes Under Control. Reason Of Recurrent Abscess?

Posted on Wed, 24 Apr 2013

Question: Hi, I'm a 60-years old male. I developed an abscess on my buttock in mid 2011. It oozed and quickly healed but recurred again in 6 months in early 2012, I was given Ciprofloxacin and it dried completely. It showed up again in 6 months (mid 2012) and got down with one more round of Ciprofloxacon. This XXXXXXX 1013, it recurred again, got bigger and I had to get it surgically drained. I was put on Ciprofloxacin again. The wound was healing good for 3 weeks but then started showing symptoms of inflammation, rupture and oozing. Its been weeks since the surgical drainage, but the wound is still oozing (2-6 drops) everyday now. Please help me understand what the reasons would be behind this recurrent abscess?

I started having joint pains in 2007 and was administered with 6 does of Penidure injection then. (It was later diagnosed as Rheumatoid arthritis)
Would an injection given in 2007 lead to an abscess in 2011?

I was recently, in Feb 2013, diagnosed with type 2 diabetes for which I have started taking medication since March 9th, (3 weeks so far). Tests performed last 2 weeks showed blood sugar in control. If the slow wound healing is attributed to diabetes, how much time should I wait to see an improvement given that I started diabetes medication 3 weeks back?

Answered by Dr. Das Arindam (39 minutes later)

Hello,

Thank you for posting a query here.

Look, after going through your description I have found the important points about you –
1.     You are suffering from recurrent abscess in buttock.
2.     You are diabetic but have good control.
3.     You are taking Medrol.

Now, Medrol contains methylprednisolone which is a steroids. It acts as a immunosuppressive. That means it lowers our body capability in preventing infections. So, it can enhance any infection and delay the healing process.

Diabetes also enhances infections over different part of our body. But you have told that your tests were ok. If you have done only the blood sugar level estimation, I think that is not enough. A normal blood sugar level at a point of time is not enough to say that you have good glycemic control. For this, you have to do a HbA1C level in blood. This will tell the glycemic control over last 3 months. This is mandatory.

If you did not have this HbA1C report, you have to do it. Otherwise, it is ok.

Now, with these two risk factors, it will not be easy to handle the infection. You have told that this present infection is not responding to ciprofloxacin. It indicates possibility of drug resistance. It is a common problem.

Here, the best way to deal with the situation is to take a swab from the wound and to send it for culture and sensitivity test. According to the sensitivity report, the perfect drug should be selected.

So, you should consult with your treating doctor about it.

The Penidure injection given in 2007 cannot give rise to this type of complicated infections.

You should not wait for anything. You should consult with your treating doctor about culture sensitivity test and then for prescribing the perfect drug accordingly.

Hope this information suffices. Let me know, if you have any more question.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Das Arindam (13 hours later)

Thank you Dr. XXXXXXX I'll have HbA1C done. My current daily intake of Medrol is 1mg. My eye vision has deteriorated a lot over the last year due to cataract. I was planning on getting cataract surgery early this year but with the recurring abscess, I'm having second thoughts. What would be your suggestion in this regard:

1. If HbA1C shows sugar under control, would it be ok to proceed with eye surgery in spite of the abscess?

2. Would eye surgery be ok on continued Medrol intake (1mg per day)?

3. Any recommendations on surgery kind (Phacoemulsification or ECCE) and lens type given my history of Rheumatoid Arthritis?

Thanks once again.

Answered by Dr. Das Arindam (11 hours later)

Hello,

Thank you for writing back.

Look, in this condition you have some infective foci. It will have some bad effects on surgery.

So, it would be better not to go for surgery right now.

First, you get totally cured, then consult with your eye specialist for operation.

If HbA1C is normal, then you can go for operation. Special care should be taken then.

Generally, operation is avoided during medrol therapy. But, in some critical condition, it can be done. The decision is totally up to your treating doctor.

The type of lens depends on the condition of eye. It is not practical to give any opinion without examining you clinically.

Hope you have your answers.

Regards.

Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar