Marc McMillan
23 year old student
PC: painful right index finger and right hand
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HPC: had been diving in the Seychelles 2 weeks ago
bitten by a fish in right index finger
initially only red, painful and hot finger tip
swelling spread to palm and wrist
then bite started oozing whitish / green pus
started shivering, had night sweats x2
now small necrotic area at finger tip
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PMH: DM Type I
Dislocated left shoulder 5 years ago (due to road traffic accident)
occasional extrasystoles, but not causing problems
hearing impaired on right side (uses hearing aid)
megacolon as a neonate
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DHx: insulin (long acting od, short acting tds)
occasionally amphetamines and XTC (MDMA, Ecstasy)
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FHx: father unknown
mother: severe RA (rheumatoid arthritis)
brother: Huntington’s chorea
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SHx: lives in dorms
non smoker, occasional binge drinking
studies law and politics