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]).
Yek C, Hendren NS, Dominguez AR. Edema and Ulceration of the Lower Extremities—All That’s Red Is Not Infection: A Teachable Moment. JAMA Intern Med. 2018;178(2):277–278. doi:10.1001/jamainternmed.2017.7194
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