A 42 year-old male alcoholic patient was admitted to emergency department due to unconsciousness and the presence of necrotic tissue on his right zygomatic arch of the face. The medical history revealed that he was a chronic alcoholic and living alone. He did not have any known medical problems or sensorial deficits. He had been lying on the right decubitis position on the floor of his house for more than 48 hours until he was found and taken to our emergency department.
On the physical examination, he was unconscious and only localised painful stimuli. He had fever of 38.4oC, tachypnea, and blood pressure of 90/40 mmHg. Peripheral pulses were present but filiform. Beside the stage III pressure sore on his right zygomatic arch of the face there were several atypical pressure sores on the right side of the thoracic cage, the right anterior superior iliac spine, the lateral aspect of the right knee, the medial side of the left knee, the scrotum and the dorsal sides of the feet (figure 1 a-c). In routine blood analysis, he had elevated liver enzymes (GGT, ALT, AST, LDH). He was in deep metabolic acidosis with blood pH of 7.68. Nothing other than chronic atrophic changes in the gray mater of the brain (cerebral and cerabellar atrophy which were probably due to chronic alcoholism) was observed in the cranial CT obtained to exclude a possible head trauma, which may the reason of unconsciousness. Multiple microorganisms (E. coli, K. pneumonia, Staph. heamaliticus) were cultured from the wound over zygomatic arch of the face. The medical status of the patient deteriorated before any surgical intervention, and he died due to cardiopulmonary arrest.
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