Question of the Week # 433

433) A 27 year old woman with no significant past medical history presents to your office after she sustained an accidental cut from a clean, new kitchen knife. She has no significant family history. She does not smoke or drink. She enjoys hanging out in beaches over the weekends and sun tanning. She however, noticed that she tans very quickly when compared to her friends. She received Tetanus immunization as a child and her last tetanus booster was 1 year ago. She also reports she recently visited her gynecologist office at which time some routine labs were done. She has the copies of her lab reports with her which reveal:
WBC : 10k/µl

HGB: 15gm%

Platelets : 300k/µl

Iron : 150 mcg/dL

TIBC: 200 mcg/dl

Transferrin saturation : 75%

Serum Ferritin : 220 ( N= 12 to 200 ng/ml)

Further investigations revealed homozygos state for C282Y mutation. On examination, her skin is golden tan in color. She has a  1cm cut on her palm which is clean. The wound is cleaned with soap and water.

Which of the following is the most appropriate management?

A) Instruct her to increase Vitamin C intake to promote wound healing

B) Administer Tetanus Immunoglobulin

C) Administer Tetanus Toxoid

D) Instruct her to avoid contact with sea water until the wound is healed

E) Instruct her to increase Red Meat Intake

 

 

11 Responses

  1. C

  2. D. Hemochromatosis, to prevent against vulnificus inf-n.

  3. d

  4. D
    Many people feel that exposing cuts to sea water can assist in the healing process. According to this article in Medpagetoday, not only is this old remedy not correct, it is downright dangerous.
    Most Vibrio infections in the U.S. are associated with eating raw or undercooked seafood, but of those studied, more than two-thirds of patients were infected while participating in recreational activities, such as boating, surfing, swimming, or walking on the beach, Dr. Dechet reported at a meeting of the Infectious Disease Society of America here.

    Avoid being in sea water if you have open cuts. If you have an infection and have been in sea water lately, let your physician know asap.

    • E

      No need for tetanus prophylaxis,
      porphyria cutanea tarda – consumption of red meat increases excretion of porphyrins in stool.

      lemme know if m wrong

      • Sorry,

        D, hemochromatosis.

  5. C-

  6. D

  7. Seawater, reason being avoid the Iron eating bacteria Vibrio Vulnificus, it’s an iron eating bacteria and this lady suffers from Bronze diabetes also called hemochromatosis, she being homozygous for C282Y mutation confirms that both her allele’s are carrying the mutation and it is autosomal dominant so there’s no way she has an acquired hemochromatosis from thalessemia or other anemia’s!

    There’s a catch here though, she is much better off swimming in sea water because estrogen protects against vibrio vulnificus! 85% of the endotoxic shock that does occur with vibrio is in males because of lack of estrogen 😉

  8. D. http://www.healthier.qld.gov.au/conditions-treatments/condition/vibrio-vulnificus-infection

  9. D: she is suffering from Hemochromatosis: iron studies result, tan skin, and c282y mutation. this patient is very prone to get V.vulnificus infection. So avoid sea water until the wound is healed.

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