docarchana
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A 35 yr old man with paraplegia comes to the physician for the followup exam. he has a decubitus ulcer over the sacrum that has not healed despite wound care and repeated debridement over the past 3 months. over the past 2 wks he has had a low grade fever and a 3.6kg wt loss. his temp is 100.6 F and BP is 120/80. examination shows a deep 4cm ulcer over the sacrum. his leukocyte count is 14000/mm3,which is consistent with previous leukocyte counts over the past month. his ESR is 98mm/hr. what is the diagnosis?
a.anaerobic infection
b.malnutrition
c.osteomyelitis
d.squamous cell carcinoma
e.type 2 diabetes mellitus
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| fox
Forum Guru
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b?
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| alexaE
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d, an ulcer that doesnt close should raise suspicion of possible squamous cell carcinoma
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| docswapna
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i also think its SCC
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| khorshid
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C.I strongly think it's osteomyelitis, , alexae you're right in a nonhealing ulcer we should think about scc, but I don't remember having a high esr in scc, but I think this case has been like this, paraplegic--->ulcer(because of possible bed rest...)---->these ulcers are hard to heal---->it has caused osteomyelitis in the adjacent bone(the pt also has fever)and in osteomyelitis most of the time we have high esr and crp
another point is the depth of the ulcer, I'm not sure but from my clinical experience scc's are not this deep, usually when they are gross they have that cone of keratin on top of them, but this depth could mean involvement of bone.
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| alexaE
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you may be right khorshid. i think i was looking mainly for the fact that he has been well taken care of, as it says in the question stem, and took into account the low grade fever and the important weight loss in such a short period of time. ESR is indeed a sign of inflammation and infection. i still have some doubts about the correct answer
maybe docarchana who posted the question has the right answer and the explanation to it
once again, thank you khorshid 
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| khorshid
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you're welcome alexae , yes I hope docarchana will post the answers soon, before my exam:-).
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