A 55-year-old woman complained of a five-day-old leg rash. She also had non-insulin-dependent diabetes, hyperlipidemia, and hypertension, which she managed with insulin, atorvastatin, and labetalol and nifedipine, respectively. A unilateral ill-defined erythematous plaque with a surface texture like orange peel occupied most of her left shin. Dystrophic left toenails and scaly plaques on the dorsal left foot were diagnosed by KOH preparation as onychomycosis and tinea pedis, respectively. The leg was tender to palpation. Doppler studies demonstrated normal vascular flow. The patient’s temperature was 38.2°C, and her WBC count was 16,500/µL with 77% neutrophils. Blood cultures were taken.
The patient, a 65-year-old white woman with a history of coronary artery disease, hypertension, hypercholesterolemia, and type 2 diabetes, presented with an existing leg eruption that had been worsening for two weeks. Current medications included aspirin, atorvastatin (Lipitor), ezetimibe (Zetia), glyburide, and hydrochlorothiazide. Scaly erythematous plaques that began on the lower leg and extended to the knees were topped by yellow-brown crusts. The eruption was pruritic but did not burn or hurt. Arterial pulses were palpable. Examination revealed tinea pedis. The patient was afebrile. Her past medical history was significant for recurrent leg cellulitis. OTC hydrocortisone 1% cream had not been beneficial.
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