A 50 year old caucasian male with a long history of non-insulin depenedent
diabetes presented with a history of an erythematous, swollen , tender right
leg of eight days duration. Approximately 24 hrs. after the onset of his
symptoms he noted the presence of multiple non-purulent, small bullae around
the ankle that drained clear fluid and left shallow ulcers. He saw his primary
care physician who gave him a topical antibiotic and oral erythromycin.
Over the ensuing36 hrs. he developed several fluctuant masses that drained
a purulent material. He consulted a dermatologist who started him on Keflex
and referred him to the Barnes Dermatology Clinic. Examination revealed
an erythematous, swollen, tender, lower right leg with the erythema extending
to just below the right knee (A). Three 3-4 cm draining abscess (B) were
present over the pretibial area and one over the dorsum of the foot. A tender,
subcutaneous fluctuant mass involving the posterior aspect of the right
calf was also noted. Shallow purulent ulcers were noted around his right
ankle. The patient was afebrile. WBC-11,800 ; blood sugar - 306 mg/dl.
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