Ischaemic limb in a 32 year old, masquerading as cellulitis

Abstract

A 32-year old man was admitted under the care of the Trauma and Orthopaedics team at a District General hospital with a 3-month history of a painful, erythematous right foot that had been preceded by parononychia of the right big toe. The presumed cellulitis was initially treated with flucloxacillin. A 5-day course of intravenous antimicrobial treatment resulted in no improvement. Clinical re-assessment revealed critical limb ischaemia. Arterial duplex and later angiography confirmed a popliteal artery occlusion. The patient underwent a femoral to below knee popliteal artery bypass with good results. This case demonstrates the importance of performing a thorough multi-system examination in cases of presumed cellulitis to avoid missing an unusual presentation of alternative pathology.