CHART NOTE
HISTORY
This is a 42-year-old white male with a persistent inflammatory ulceration on the dorsum of his right foot which began as athlete’s foot. The patient reports a similar dermatitis approximately 5 years ago which cleared over several months with an unknown antibiotic. The patient was first seen in the dermatology clinic and was thought to have infected eczema or gram-negative toe web infection and possible contact sensitivity to Neosporin. The patient was started on oral griseofulvin and Burow soaks. Bacterial cultures grew mixed flora including Pseudomonas, Lactobacillus, and group D strep. Fungal cultures grew yeast, not thought to be Candida albicans.
Three weeks ago when I saw the patient, I stopped the Burow soaks and griseofulvin and started him on potassium permanganate soaks and ketoconazole 200 mg p.o. b.i.d. as well as Augmentin 500 mg p.o. t.i.d. and Hibiclens soaks.
X-rays showed mild demineralization but no definite osteomyelitis.
The dermatitis apparently cleared after 3 or 4 days of ketoconazole and Augmentin, but recurred after 2 weeks.
PLAN
It is felt that the patient should be kept on at least 6 months of oral ketoconazole and could possibly need IV amphotericin B in the future if lesions do appear.
FOOTNOTE
Line 33. Alternative: I.V.
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