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A morbid case of leg swelling
  1. Allen Bookatz,
  2. Timothy Jang
  1. Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Harbor-UCLA Medical Center, Torrance, California, USA
  1. Correspondence to Dr Timothy Jang, Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Harbor-UCLA Medical Center, 1000 W. Carson St., Torrance, CA 90509, USA; tbj{at}ucla.edu

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Case vignette

A 24-year-old man without past medical history complains of left leg swelling and pain. Six weeks ago, he was kicked playing football and developed a non-displaced fracture of his mid-left fibula. He was immobilised and developed normal weight bearing after 4 weeks. Over the last 3 days, he developed pain, swelling, and inability to weight bear with his left leg along with some chills and sweats. On exam, all vital signs were normal but his left leg was warm, indurated, and red without fluctuence or discharge figure 1. The compartments were soft, but pain was illicited with calf compression. His distal neurovascular exam was intact except for a foot drop.

Figure 1

Image of the damaged leg on admittance.

Case questions

  1. What is the differential diagnosis?

  2. What are the key historical and clinical features of this case?

  3. Ultrasound images are attached. Figure 1 is the unaffected leg. Figures 2 and 3 are the middle of the lateral compartment of the left leg. Figure 4 is the lateral compartment of the left leg. What do they demonstrate?

  4. What are the stages of pyomyositis?

  5. What …

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