Case #4 - A Child With Painless Wounds

Janaina Nogueira, MD, Janice Ford, MD, Mary Mancao, MD, Paul Maertens, MD


March 17, 2003

Subsequent Evaluation and Hospital Course

Upon admission, blood cultures were drawn and a culture from the great toe wound was obtained. Intravenous (IV) cefazoline was started empirically. Consultations from Neurology and Orthopaedics were obtained. A neurologic workup was performed to investigate possible causes of the peripheral neuropathy. The results of a hemoglobin A1c; heavy metal screen; levels of vitamins B12, B6, and E and creatinine phosphokinase; serum protein electrophoresis; serum immunoelectrophoresis; and serum cryoglobulins were all within normal limits.

The culture of the great toe wound subsequently grew Enterococcus spp. An MRI of the spine was also within normal limits.

Motor conduction study of the peroneal nerve and left median nerve bilaterally revealed mildly slowed motor conduction velocity and significantly small compound muscle action potential amplitude. Right ulnar and tibial nerve motor conduction study showed low normal motor conduction velocity and normal compound muscle action potential amplitude.

Needle examination of the right lower extremity revealed signs of subtle denervation and reduced interference pattern in the feet muscles, consistent with neuropathy. The findings from this study were indicative of motor-sensory neuropathy, predominantly sensory, most likely hereditary.

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