What causes recurring painful lesion extending from wrist to underarm?
? Acute lymphangitis / ? Cutaneous larva migrans
Welcome to healthcare magic.
I understand from your query that your child has been having a recurring painful lesion extending from her wrist to her underarm.
From your history and description, the possibilities I can think of are Acute Lymphangitis , Thrombophlebitis and Cutaneous larva migrans.
Lymphangitis is an infection of the lymph ducts in the skin an underlying soft tissue.
Thrombophlebitis is inflammation of the veins.
Cutaneous larva migrans occurs due to the entry of the nematode larva ( after contact with dirty water like puddles/ playing in a sandpit, etc) which travels and creeps under the skin.
Lymphangitis and thrombophlebitis tend to respond well to antibiotics. However, in your child's case, it seems to recurring after the course of antibiotic is over. This could occur
1. If the underlying bacteria is resistant or not completely responsive to the antibiotic administered.
A swab from the blister or aspiration from the inflammed edge of the red line may help to identify the organism and find out its sensitivity pattern. Since the blister has already dried up, an aspiration might help.
2. If your child has any underlying immunosuppression - Does your child have any other medical issues like diabetes or is she on any drugs like steroids?
The 3 rd possibility I would consider is Cutaneous larva migrans. This is generally painless but can become painful if the lesions gets secondarily infected by a bacteria. This requires treatment with an anti -larval like oral Ivermectol.
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I understand that your child is due for an ultrasound in 2 days. In the meantime, you could try the following measures to give her symptomatic relief.
1. Keep the limb elevated.
2. Do not move the affected area too much. Try to keep it immobile.
3. Hot, moist compresses will help to provide relief from pain.
4. Anti- inflammatory and analgesics like Acetaminophen and Ibuprofen can be given for pain relief.
It would be good if you could send me the clinical picture.
Hope this helps you to provide some relief to your daughter.
Dr. Johny Chacko
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