Case 2 :

A 65-year-old male presents to the ED with 24 hours of severe left ankle pain. The patient noticed the pain upon awakening yesterday AM. It rapidly became so severe he could not bear weight on it. He denied trauma and has never had similar pain in the past in this or any other joint. On ROS he has noted a low-grade fever for 1 day.

Past History: HTN


Type II diabetes

Patient has a small pustule on his left toe , which he treated himself with warm compresses, resolving with resolution

Meds: ASA, glyceride, lisinopril, digoxin, lasix, isordil

PE: Left ankle is very swollen, red and tender. Passive and active motion is markedly limited by pain. He has a 5 mm shallow ulcer over the left 5 th toe with minimal surrounding erythema. There is no edema. He has normal sensation in his feet. Heart, lung and abdominal exam is unremarkable.