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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Do Hard Red Lumps On Different Parts Of A Quadriplegic Patient Indicate?

I have a patient, quadraplalegic, who has been exhibiting hard red lumps in the morning. One just before the big toe, where you would normally see a bunion, and one on the side of his knee. Feels hard like bone and generally goes away by afternoon, sometimes not. This has been going on for a while, not always in the same spot. He has a couple of pressure wounds being treated and is taking protein supplements even though he eats a lot of protein in his diet, which is mainly meat, eggs cheese and a lot of Vegis. What do you think?
Tue, 7 Jan 2020
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General Surgeon,  's  Response
Hi,

Noted the history about your quadriplegic patient developing hard lumps near great toe and knee every morning which settles by afternoon, pressure wound being treated, on protein supplements and high protein diet.
Since the lumps are hard in the morning, on the same spot and settle by afternoon, the commonest cause I can think about is FDR that is fixed drug reaction, it is not necessarily the medicine but can be anything else like spices, preservatives in foods and medicines that cause the reaction.
This is sort of a angioneurotic edema.
As the lumps ae formed only at two same spots again and again, give antihistamine and see the results.
Oral steroid only if required.
To find out the foods, beverages, medicines, any other factors that cause such lumps and stop these altogether.
This does not look to be a serious matter.
Take care about the pressure sores well.
It is always better to get the proper investigations of blood, urine and stool to know any problems which can then be treated specifically.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. T. Chandrakant, General Surgeon
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What Do Hard Red Lumps On Different Parts Of A Quadriplegic Patient Indicate?

Hi, Noted the history about your quadriplegic patient developing hard lumps near great toe and knee every morning which settles by afternoon, pressure wound being treated, on protein supplements and high protein diet. Since the lumps are hard in the morning, on the same spot and settle by afternoon, the commonest cause I can think about is FDR that is fixed drug reaction, it is not necessarily the medicine but can be anything else like spices, preservatives in foods and medicines that cause the reaction. This is sort of a angioneurotic edema. As the lumps ae formed only at two same spots again and again, give antihistamine and see the results. Oral steroid only if required. To find out the foods, beverages, medicines, any other factors that cause such lumps and stop these altogether. This does not look to be a serious matter. Take care about the pressure sores well. It is always better to get the proper investigations of blood, urine and stool to know any problems which can then be treated specifically. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. T. Chandrakant, General Surgeon