Two weeks before Christmas my nearest & dearest tried to stop our half
stray tom cat from fighting with the one next door. He sustained a 1cm
laceration over the left 5th MCPj on the dorsum of the hand. I washed it
and dressed it. Twelve hours later it was swelling so I started him on
Clarithromycin, but after another six hours he had a fever of 39.4, was
toxic and had marked swelling of his hand, so into hospital he went. Two
days of i.v. Flucloxacillin & Metronidazole had settled the systemic
toxicity but he was discharged home after a single flawed temperature
reading (from 38C to subnormal in 4 hours?). He was dehydrated (one arm
elevated, one with a Venflon, and feverish), he was constipated (same
condition and Codeine 30mg q4h) and dirty (same condition and nurses too
busy). The hospital lost his medication to take home, so they told him to
come back in 24 hours for it!
Anyway, he got home & I had him on 500mg Flucloxacillin qds & 400mg
Metronidazole tds but he started with rigors so I added Ciprofloxacin 500mg
tds. Things began to settle, but every time he elevated his arm he got
urticaria on the left forearm. This settled only a little with
Chlorpheniramine. After two weeks of antibiotics things looked almost
settled but the fever, the rigors and the headache returned within 24 hours
of stopping the antibiotics on Christmas Day. We started him on
Co-Amoxiclav & Ciprofloxacin and last weekend I drained three separate
abcesses of about 15ml anchovy coloured pus. Later discovered the hospital
had not bothered taking a swab or blood cultures when he was admitted, but
any pus would probably have been sterile by now.
Finally things are settling down, but he has had excruciatingly intensense
pruritis over the site of where the abcess was every time he lay down.
Sitting up the itching stops within 15 minutes, lying down it recurs within
5 minutes. Chlorpheniramine in doses up to 40mg daily does very little. It
has settled over the last three nights. The itching has baffled all I have
spoken to, does anyone have a mechanism to offer, rather than a " it's a
histamine type thingy" brush off?
At least I've learnt never to trivialise animal scratches!
Best Regards for the New Year,
Vic Calland
P.S. The M.I.O. bag jpg's etc will be sent out when I get back from a weeks
teaching in Saalbach. Somebody has to do it I suppose!
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