Infectious Disease
Case 5: A Patient with Presumed Infection
CASE
A 56‐year‐old lady presented to A&E with malaise and a fever. She was discharged 1 month ago following emergency surgery for a fractured neck of the femur. The procedure had been event free and she was now mobilizing with crutches. She complained of pain and swelling of her right leg and found walking increasingly difficult. She had no chest symptoms. She had a past history of breast cancer but has been in remission for 10 years with regular follow‐up. Other than analgesia she is not on regular medication. She is not aware of any conditions that run in the family.
On examination she was febrile at 38°C with a heart rate of 95 beats/min, an arterial blood pressure of 115/70 mmHg, respiratory rate of 18 breaths/min with an oxygen saturation of 99% on air. Cardiovascular, abdominal and respiratory examinations were unremarkable. She had an asymmetrical swelling of her right leg extending to her mid‐thigh. This area was red and she was exquisitely tender around the calf and the pain was exacerbated by forced foot dorsiflexion.
The following results were obtained:
Hb 13 g/L WCC 10 × 109/L Platelets 240 × 109/L CRP 20 mg/L ESR 20 mm/h D‐dimer Elevated Na 138 mmol/L K 4.1 mmol/L Urea 4 mmol/L Creatinine 120 µmol/L LFTs Normal
Blood culture: no growth
QUESTION 1
Your score this session: 0 of 0
What further investigation would you request