A 73-year-old male patient was admitted to our hospital because of fever and pain of the left tibia.
His past medical history was significant for diabetes mellitus (managed with oral antidiabetic agents) and lung cancer for which he underwent resection of the left upper lobe one year ago. The patient also received chemotherapy that was completed 1 month ago.
Physical examination showed a red area of the left tibia (Figure). His temperature was 37.40C. Routine laboratory testing showed: C-reactice protein 30.50 mg/dL (normal value (0-0.50 mg/dL), creatinine 1.7 mg/dL (0.8-1.3 mg/dL), urea 61 mg/dL (15-50 mg/dL), hematocrit 28.1% (41.0-53.0%), white blood cell count 9.19 K/ìl (4.50-11.00 K/ìl).
An ultrasound of the lower extremities arteries and veins was performed which showed a generalized atherosclerotic disease, including a total obstruction of the left superficial femoral artery.
What is your diagnosis? What should be done?
Matthew E. Falagas, MD, MSc, DSc
George Peppas, MD, PhD
Panayiotis J. Papagelopoulos, MD, DSc
Konstantinos Rellos, MD