Why Is This Man’s Leg Painful, Swollen, and Red?

Author:
David L. Kaplan, MD—Series Editor
University of Missouri Kansas City, University of Kansas

Citation:
Kaplan DL. Why is this man’s leg painful, swollen, and red? Consultant. 2013;53(6). 

For the past few days, a 63-year-old man’s lower leg has become painful, itchy, swollen, and red. The patient is afebrile and takes no medication. Another practitioner suspects an infectious cause and orders a complete blood cell count and bone films and a nuclear scan to rule out osteomyelitis. Pending the laboratory findings, a fluoroquinolone antibiotic is prescribed.

(Answer and discussion on next page.)

ANSWER: Stasis dermatitis

The presence of itching and pitting edema, the failure of the fluoroquinolone to ameliorate the pain, and the absence of predisposing factors to infection, such as underlying disease (eg, diabetes mellitus), trauma (venous stripping or lower extremity surgery), A, or toe web disease, D, led to the clinical diagnosis of stasis dermatitis. All laboratory test results were normal. The use of a mid- to high-potency topical corticosteroid and support hose resolved the symptoms.

 David L. Kaplan, MD, is clinical assistant professor of dermatology at the University of Missouri Kansas City School of Medicine and at the University of Kansas School of Medicine. He practices adult and pediatric dermatology in Overland Park, Kansas.