    [On-duty note]
This 47-year-old female has been bobust and denied any systemic diseases. She claimed that she had car accident and got fracture of right ankle in Feb, 2008. She received internal fixation susgery and was regularly followed-up in  Hospital. No abnormalities of bony structures of bony structure were noted. She noted sudden onset of fever episodes on 9/16. No cough/rhinorrhea, no diarrhea, no dysuria were noted. She found her right ankle painful swelling with erythematous change on 9/17. No skin eruption was noted. Exposure to insect bite or wild plants was denied. She visited ER for help. Vital signs at ER revealed: BT 36.8 degrees, PR 80/min, RR 14/min and BP 139/98 mmHg. PE revealed right ankleswelling extending to lower portion of the calf. Mild tenderness was noted. CBC disclosed no obvious leukocytosis(WBC=6100/cumm) and microcytic anemia. CRP=134.62 mg/L. Elevated liver function tests were also noted(ALT/AST=84/101 IU/L). Under the impression of cellulitis, she was admitted for further eveluation and management.
After admission, Oxacillin 2gm Q6H was prescribed. Because her blood culture yielded Stenotrophomonas maltophilia growth, infection was consulted and antibiotics was changed to Alvelox 400mg QD from 9/23. But severe adverse effects were noted(dizziness, tachycardia). Antibiotics was altered to Ceftazidime 2gm Q8H from 9/24. Orthopedics was consulted and keeping current antibiotics treatment was suggested. Besides, serum CRP level was checked and showed a decling trend. After changing to Ceftazidime, no adverse effects were noted. Besides, bone scan revealed findings compatible with osteomyelitis. 
For surveying elevated liver function tests, abdominal sonography was arranged and revealed fatty liver. Hepatitis markers were negative. Now we will keep cefatazidime 
usage and follow lab data.



(1)Celulitis of right ankle and osteomyelitis:
  @Local heat(+)
  @erythematous change: improved
 Plan :
  @Keep Ceftazidime use

(2)Post-menopause:
 Plan :
  @Keep observation
  @Hormone replace therapy if necessary

(3)microcytic anemia:
  @have improved
 Plan :
  @follow lab data