Case 1

An 81-year-old lady patient who lives alone, attends your ED with a 3-day history of a painful, swollen right lower leg.

She has been sleeping in her chair as she has been unable to get upstairs due to the pain. She feels unwell and has not been eating for the last two days. She has a history of a right deep vein thrombosis seven years ago after a myocardial infarction, and has longstanding mild chronic renal impairment, (creatinine 172).

On examination, she is apyrexial. Her right leg is red, warm, tender, and swollen.

Which of the following features would support a diagnosis of cellulitis rather than deep vein thrombosis?

Select one or more options.

You perform some blood tests, with the following results:

• White cell count 13 500 x10⁹ /L
• CRP 70 mg/L
• D-dimer 850 mg/L (normal range, up to 500)
• Blood glucose 5.2 mmol/L

Which further investigations are necessary?

Select one or more options.

The patient is keen to go home and is sure her neighbours will help her to manage. You know that district nurses can give community intravenous antibiotics in your region.

Should the patient be admitted or allowed to go home?

The patient gets better and goes home, but returns to your ED twice over the next 7 months with recurrent episodes of leg cellulitis. While she is in your observation ward having intravenous antibiotics you wonder whether any additional management would help.

Which of the following would you consider?

Select one or more options.