A Diagnostic Challenge for a Rare Condition

​BY GREGORY TAYLOR, DO, &SCOTT LAGERVELD, DOA 54-year-old man with a significant past medical history of atrial fibrillation and congestive heart failure presented to the ED with a chief complaint of difficulty walking. He was evaluated at an outside hospital two months earlier, and was found to have methicillin-resistant Staphylococcus aureus bacteremia, lower extremity cellulitis, and acute decompensated congestive heart failure (CHF). He clinically improved over one week, his autoimmune workup was negative, and he was discharged. He failed to follow up with nephrology, cardiology, and dermatology, and stopped taking his medications soon after discharge.He presented to our ED with worsening lower extremity edema, dyspnea on exertion, worsening skin lesions for six months, and frequent nose bleeds for three days. The patient had no hematemesis, melena, hematochezia, no prior EGD, or colonoscopy. His medications were apixaban, digoxin, and furosemide.His vitals on arrival were a temperature of 97.7°F, blood pressure of 196/92 mm Hg, heart rate of 97 bpm, respiratory rate of 32 bpm, weight of 487 pounds, and oxygen saturation of was 92% on room air. He had respiratory distress with conversational dyspnea and dried blood in the right nostril. Cardiopulmonary exam revealed an irregularly irregular rhythm and rales in the lung bases. His lower extremities had 3+ pitting edema with associated chronic venous stasis changes. His lymphadenopathy exhibited clear dr...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research

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