Methods (Differential diagnosis, investigations and treatment)
In light of the sudden leg swelling, we considered a differential
diagnosis of cellulitis, lymphoedema, chronic venous insufficiency,
hematoma, deep vein thrombosis (DVT), and a ruptured Baker cyst. Due to
the suspicion of DVT as a primary diagnosis, we evaluated the patient’s
D-Dimer level along with other routine tests. The assessment revealed an
elevated D-Dimer level (4840.94 ng/ml), and we initiated subcutaneous
intravenous heparin therapy at a dosage of 5000 units. To confirm the
diagnosis of DVT, Doppler vascular ultrasound of the left leg was
conducted, which indicated normal venous diameter and no signs of DVT or
thrombosis. Based on the ultrasound results, the next step for a
definitive diagnosis is a magnetic resonance imaging (MRI).
Subsequently, an MRI of the left leg and sole was performed for further
evaluation.
The radiologist’s report indicated edema in the second metatarsal with
inflammatory aspects, suggesting early stages of osteomyelitis. This
finding led to the ruling out of the diagnosis of DVT.
In response to the patient’s complaint of dysuria, a urinalysis was
performed, revealing elevated levels of white blood cells (25-30
WBC/hpf), red blood cells (3-5 RBC/hpf), epithelial cells (2-3/hpf),
mucus, and bacteria, along with a positive test for T. vaginalis(Figure 1 ). The absence of glucosuria or urinary casts was
noted. The patient was administered a single dose of 2 grams of
metronidazole and underwent a recheck of urinalysis (U/A) and urine
culture (U/C).