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Surgery pp 29–33Cite as

Right Leg Pain, Swelling, and Erythema for Two Days

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A 40-year-old male with diabetes mellitus and hepatitis C-related cirrhosis presents to the emergency department with a 2-day history of right leg pain, redness, and swelling. He states that he thinks he may have been bitten in the leg by a bug while sleeping. On physical examination, his temperature is 37.8 °C, 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, and an area of 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), white blood cell (WBC) count 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).


  • Necrotizing soft tissue infection
  • Cellulitis
  • Gas bubble
  • Crepitus
  • Diabetes
  • Violaceous
  • Clostridium
  • Gas gangrene
  • Necrotizing myositis
  • Fournier’s gangrene

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  • DOI: 10.1007/978-3-030-05387-1_4
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Suggested Reading

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  • Wall DB, de Virgilio C, Black S, Klein SR. Objective criteria may assist in distinguishing necrotizing fasciitis from nonnecrotizing soft tissue infection. Am J Surg. 2000;179(1):17–20.

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  • Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;32(7):1535–41.

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  • Wysoki MG, Santora TA, Shah RM, Friedman AC. Necrotizing fasciitis: CT characteristics. Radiology. 1997;203(3):859–63.

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Correspondence to Monica Lee .

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Lee, M., Chen, D.C., Grigorian, A., Frank, P.N., de Virgilio, C. (2020). Right Leg Pain, Swelling, and Erythema for Two Days. In: de Virgilio, C., Grigorian, A. (eds) Surgery. Springer, Cham.

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-05386-4

  • Online ISBN: 978-3-030-05387-1

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