Presenter: Matthew Smetanick, D.O., Gregg Severs, D.O., J. Greg Brady, D.O.

Dermatology Program: Frankford Hospital/PCOM

CHIEF COMPLAINT:  painful, swollen left foot following trauma


CLINICAL HISTORY: A 69-year-old, otherwise healthy woman was seen in our office for a painful, swollen left foot. She reported a two-week history of worsening symptoms after stepping on a sharp object while walking barefoot at home. The patient experienced pain at the base of her left first toe, but could not identify an obvious puncture wound or foreign body at the time of injury. Initially, the patient was seen at an urgent care center and was treated with prednisone for a suspected bite reaction on her toe. The patient was then seen five days later by her primary care physician and received cephalexin for suspected cellulitis. Her prednisone was also discontinued at that time. Her past medical history was significant for hypertension and hyperlipidemia. Medications included olmesartan, rosuvastatin, and a multivitamin. The patient admitted to having chills a few days prior to her presentation at our office. The patient was sent to the emergency room for cultures and radiographic studies. She was subsequently admitted and placed on empiric antibiotic therapy with clindamycin and vancomycin. The patient was also started on itraconazole to cover a possible fungal infection, pending tissue biopsy, and culture results.