Is Difficult to Ambulate

The discussion today involved a 54 year old gentleman with a history of polysubstance IV abuse,  HTN,  and bilateral degenerative changes of the knee s/p left knee replacement who presented with 1.5 weeks of RLE pain of burning nature. Along with worsening erythema and swelling, the gentleman also had difficulty with ambulation.  What initially was thought to be an uncomplicated cellulitis progressed into obtaining further imaging and changing management for a large intramuscular abscess with probable osteomyelitis. Highlights included:

* Recognition of the acuity of a patient’s clinical condition, with a quick review of the Systemic Inflammatory Response (SIRS) criteria

*  Cognizance of the value of consulting sub-specialty services to help further assist with clinical reasoning

* Acknowledement of the challenges of early diagnosis of osteomyelitis

*  Review of the pathophysiology for osteomyelitis and comparison of the various modalities needed for proper work-up

Review these articles here (the role of imaging and here) for further understanding.