DATE OF CONSULTATION: MM/DD/YYYY
REFERRING PHYSICIAN: John Doe, MD
REASON FOR CONSULTATION: Extensive furunculosis and abscesses.
Thank you very much for this infectious disease consultation.
HISTORY OF PRESENT ILLNESS: The patient is a pleasant (XX)-year-old gentleman who states that for the last several days, he has had increasing abdominal wounds and draining abscesses throughout his abdomen, leg, and arm. He had a fever when he first came in and was admitted and started on IV antibiotics. These grew MRSA, and the patient had been on Zosyn and was then changed to anti-staph medication. He is doing better at this point, but there are still various lesions that have not yet opened up and drained. He is otherwise doing well. There are no other medical problems.
MEDICATIONS: Reviewed, including doxycycline IV.
ALLERGIES: The patient has no known drug allergies.
SOCIAL HISTORY: The patient does not drink or smoke.
FAMILY HISTORY: Noncontributory.
REVIEW OF SYSTEMS: A 14-point review of systems was obtained from the patient and is significant for issues stated in the HPI.
PHYSICAL EXAMINATION:
VITAL SIGNS: Temperature 98.2 degrees, pulse 64, respirations 18, and blood pressure 134/72.
GENERAL: The patient is alert and oriented, in no apparent distress.
HEENT: The patient is normocephalic and atraumatic. Pupils are equal and reactive to light. Extraocular motions are intact. No scleral or conjunctival lesions. Nares are clear. Oropharynx including lips, teeth, tongue, and posterior oropharynx are clear without exudate or lesions.
NECK: Supple, no lymphadenopathy or thyromegaly.
LUNGS: Clear.
HEART: Regular rate and rhythm without murmur.
ABDOMEN: Soft and nontender. There are extensive abdominal wounds and abscesses with draining pus.
EXTREMITIES: The patient has multiple areas on his leg and also on his right arm of undrained abscesses; they are all consistent with staph abscesses.
NEUROLOGIC: Grossly nonfocal.
There is no peripheral lymphadenopathy identified.
LABORATORY DATA: Laboratories have all been reviewed.
ASSESSMENT:
1. Extensive furunculosis with severe abscesses on his abdomen, leg, and arm. These all started just within the last few days.
2. Leukocytosis secondary to extensive furunculosis with severe abscesses on his abdomen, leg, and arm.
3. Status post fever.
PLAN:
1. At this time, we will initiate IV daptomycin 4 mg/kg every 24 hours.
2. We will obtain a PICC line.
3. General surgery consult.
4. Check HIV test.
5. We will attempt to decolonize with Hibiclens and Bactroban.
6. We will follow along with you.
