Abstract
A 40-year-old male with diabetes mellitus and hepatitis C-related cirrhosis presents to the emergency department with a two-day history of right leg pain, redness, and swelling. He states that he thinks he may have been bitten in the leg by some kind of bug while sleeping. On physical examination, his temperature is 100.5 °F, heart rate is 110/min, blood pressure is 90/60 mmHg, and respiratory rate is 18/min. His right leg is markedly swollen as compared to the left. The skin overlying the calf region is erythematous, with one 3 cm bullae that in the center has violaceous skin. There is no palpable crepitus. Plain X-ray of the leg demonstrates gas bubbles within the soft tissue in the calf. The foot itself is pink and warm, with normal pulses. Laboratory values are significant for a BUN of 40 mg/dL (normal 7–20 mg/dL), serum glucose of 200 mg/dL (70–100 mg/dL), creatinine of 1.6 mg/dL (0.8–1.4 mg/dL), WBC of 24 × 103/μL (4.1–10.9 × 103/μL), hemoglobin of 9.5 g/dL (13.8–17.2 g/dL), and a serum sodium of 128 mEq/L (136–144 mEq/L).
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