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Teachable Moment
February 2018

Edema and Ulceration of the Lower Extremities—All That’s Red Is Not Infection: A Teachable Moment

Author Affiliations
  • 1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
  • 2Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
JAMA Intern Med. 2018;178(2):277-278. doi:10.1001/jamainternmed.2017.7194

A 65-year-old man with systolic heart failure and obesity presented to the emergency department with progressive bilateral leg swelling since running out of oral diuretics 10 days prior. On presentation he was afebrile (97.7°F) with a heart rate of 65 bpm and blood pressure of 148/99 mm Hg. Examination revealed elevated jugular venous pressure, bibasilar pulmonary rales, and symmetrical pitting edema of the lower extremities with overlying nontender erythema, areas of hyperpigmentation, scaling and serous crusting, and warmth to palpation. Laboratory testing revealed a white blood cell count of 9.8 × 109/L (reference range, 4.2-10.3 × 109/L [to convert to /μL, divide by 0.001]) and C-reactive protein (CRP) level of 0.4 mg/dL (reference range, 0.0-0.5 mg/dL [to convert to nmol/L, multiply by 9.524]).