CASE REPORT


https://doi.org/10.5005/jp-journals-10084-12148
Pondicherry Journal of Nursing
Volume 13 | Issue 2 | Year 2020

A Rare Case of Carbuncle at the Right Lumbar Region: A Case Report


Rajalakshmi Rajaraman1, K Renuka2

1,2Department of Community Health Nursing, Kasturba Gandhi Nursing College, Sri Balaji Vidyapeeth, Puducherry, India

Corresponding Author: Rajalakshmi Rajaraman, Department of Community Health Nursing, Kasturba Gandhi Nursing College, Sri Balaji Vidyapeeth, Puducherry, India, Phone: +91 6383961238, e-mail: rajalakshmielayaraja@gmail.com

How to cite this article Rajalakshmi R, Renuka K. A Rare Case of Carbuncle at the Right Lumbar Region: A Case Report. Pon J Nurs 2020;13(2):37–38.

Source of support: Nil

Conflict of interest: None

ABSTRACT

A 77-year-old client got admitted to Mahatma Gandhi Medical College and Research Institute with the signs and symptoms of swelling in the right-side lower back and pain with discharge. He has been diagnosed to have carbuncle–right lumbar disorder. Carbuncle is a rare condition that may be misdiagnosed clinically, because of the atypical nature of the disease. Hence, a clear clinical picture is necessary for the identification and correct diagnosis of the case.

Keywords: Abscess, Carbuncle, Saucerization, Staphylococcus skin infection..

INTRODUCTION

An abscess or furuncle appears beneath the skin in the hair duct which is caused mostly by the Staphylococcus aureus bacterial infections (red colored, bulgy, aches, irritation, and discomfort with pus collection which later leaves a scar).15 It is otherwise called as a staph skin infection. The study findings proved that the typical site of carbuncle was neck (40%) followed by the back (26.67%). Around 40% of the clients with the symptoms of more than 2 weeks duration.6 About 20% of the clients feel the necessity for repeat surgery. Mostly, it occurs as a single, to occur on a hairy area of the body such as the back or nape of the neck but a carbuncle also can develop in other areas of the body such as the buttocks, thighs, groin, and armpits.3 The detailed content of the case report was given below.

CASE DESCRIPTION

Case History and Physical Examination

A 77-year-old client got admitted in Mahatma Gandhi Medical College and Research Institute with the signs and symptoms of swelling in the right-side lower back for 5 days which was insidious in onset, progressing gradually to attain the present size. The pain was pricking type, non-radiating, aggravating on movement, and relieves on resting in a prone position, foul-smelling purulent discharge from the swelling for past 3 days. There is no history of fever, cough, constipation, or loose stools. There was a significant past medical history of mucoepidermoid parotid gland cancer for which he underwent parotidectomy surgery 6 months ago. He also has facial palsy with features like drooping of the eyelid in the right side, drooling of saliva in the right side, and the loss of expression on the right cheek. He has been diagnosed to have carbuncle–right lumbar disorder. The physical examination of the lower back found swelling 10 × 8 cm with irregular-edged vague mass in the lower back, present with pus, skin discoloration over swelling, and the presence of skin erythema.

Investigations

USG—Swelling on the Back Findings

An ill-defined collection measuring 1.9 × 1.5 × 1.3 cm (volume 2 cc) with marked surrounding inflammatory changes and peripheral vascularity is noted at the right lumbar region at the site of the swelling. Mobile, thick echogenic contents are noted.

Course in the Hospital

He was admitted to the hospital on January 20, 2020, and underwent saucerization, incision, and drainage on January 21, 2020, under general anesthesia. The patient recovered well postoperatively. The culture was sterile and the cadexomer dressing was done and discharged on January 24, 2020, with below-mentioned drugs:

T. Paracetamol650 mgp/o1–0–12 days then SOS
T. Pantoprazole40 mgp/o1–0–15 days
T. Rutoheal1 Tabp/o1–0–15 days
Fourts B1 Tabp/o0–1–015 days
Lacrigel ointment intraocular0–0–1
Lubrex eye drop intraocular1–1–1

DISCUSSION

The management of clients presenting with carbuncle depends on the clinical manifestations. Majority of clients will recover with conservative treatment (requiring analgesia, anti-inflammatory and antibiotic). However, the most common surgical approaches are saucerization, and incision and drainage (IandD).711

CONCLUSION

Boils and abscesses are generally thought to be more common in males, although there are some published data to support this.12

DECLARATION OF PATIENT CONSENT

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has given his consent for his clinical information to be reported in the journal. The clients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

REFERENCES

1. Carbuncle; Available from http://en.wikipedia.org/wiki/Carbuncle.

2. Tripathy BB. Landmarks in the history of diabetes. In: RSSDI textbook of diabetes mellitus. 2nd ed., 2008. pp. 7–45.

3. https://www.healthline.com/health/carbuncle.

4. https://www.webmd.com/skin-problems-and treatments/guide/carbuncles-causes-treatments#1.

5. https://medlineplus.gov/ency/article/000825.htm.

6. Jain AKC, Nisha ST, Viswanath S. Carbuncle in diabetics-our experience. Sch J App Med Sci 2013;1(5):493–495.

7. Mohammed JA, Al-Ajmi S, Al-Rasheed AA. Surgical management of post carbuncle soft tissue defect in diabetic patients. Middle East Journal of Family Medicine 2007;5(4).

8. Chelliah G, Hamzah AA, Ahmed MZ, Ahmad RS. Carbuncle of the chin: A case report and literature review. Libyan J Surg 2013;2:839571.

9. Bhat SM. SRB’s manual of surgery.India: Jaypee Brothers, Medical Publishers; 2009.

10. Das S. A concise textbook of surgery. 3rd ed.,India 2001.

11. Franklin RH. The treatment of carbuncles. Postgr Med J 1937;13(142):284–287. DOI: 10.1136/pgmj.13.142.284.

12. National Institute of Health and Care Excellence Boils, carbuncles and staphylococcal carriage. http://cks.nice.org.uk/boils-carbuncles-and-staphylococcal carriage#!scenario:1.

________________________
© The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.