RT Book, Section A1 Jobst, Erin E. A1 Panus, Peter C. A1 Kruidering-Hall, Marieke SR Print(0) ID 1192818554 T1 Antifungal and Antiparasitic Agents T2 Pharmacology for the Physical Therapist, 2e YR 2020 FD 2020 PB McGraw-Hill Education PP New York, NY SN 9781259862229 LK accessphysiotherapy.mhmedical.com/content.aspx?aid=1192818554 RD 2024/11/08 AB CASE STUDYA.G. is a 29-year-old woman who returned from a military deployment in the Middle East 2 months ago. She was admitted to a military rehabilitation hospital 4 days ago for an amputee rehabilitation program. She sustained a transtibial amputation of the left lower extremity 1 week ago, secondary to a traumatic injury that occurred during a military operation. Prior to injury, A.G. was functionally independent and an avid basketball player. At admission, A.G. was noted to have several crusted raised lesions that were up to 1 inch in diameter on her face, neck, and left forearm. She reported that the lesions were much larger and painful several weeks ago. An infectious disease physician sampled skin scrapings of the lesion and diagnosed the condition as cutaneous leishmaniasis. A.G. was started on a 20-day intravenous course of sodium stibogluconate, which she receives once per day, immediately prior to afternoon physical therapy sessions. A.G. is very motivated to return to her prior level of function and has been participating in physical therapy twice per day since admission. During the first week, she met each therapy goal regarding residual limb edema control, stretching, strengthening, and pregait activities. She was making remarkable gains in therapy until 5 days after initiation of IV sodium stibogluconate when her energy level began declining, and she was unable to complete an hour of physical therapy. Today, while exercising in the parallel bars, she had to sit down twice secondary to dizziness. A.G. complains of severe hip and knee pain, as well as gluteal, quadriceps, and back muscle soreness. Although A.G.’s symptoms may be the result of her vigorous participation in rehabilitation, the physical therapist noted that some symptoms might be adverse effects of the new drug therapy. The therapist encouraged A.G. that these symptoms were likely to dissipate once the full course of drug therapy had been completed. A.G. stated that the drug treatment “has been far worse than these little sores.” She states her intention to tell the doctor that she is no longer going to take the prescribed medication, so that she can “get on with rehab.”