One diagnosis and a billion dollars
Both of her legs ached for weeks, but there had been no recent trauma or injury. Her legs were a dark red color and not getting any better. Allison, a relatively healthy, 57-year-old woman, came to the emergency room complaining of red and painful skin on her lower legs. After a history, physical exam and assessment, the emergency department admitted Allison to the hospital for IV antibiotic therapy for cellulitis, a potentially life-threatening bacterial infection of the skin and deeper soft tissue.
I was immediately interested in Allison’s case, to provide her with care and also because of a study I was leading related to misdiagnosis for the problem area of patients with a red leg rash and presumed cellulitis. The study was designed to measure the accuracy of diagnosis by examining consecutive patients admitted to the hospital for cellulitis. Allison represented yet another case of the correct therapy for the wrong diagnosis, as she did not need hospitalization or antibiotics. When I spoke with Allison during a procedure that proved an alternative diagnosis, she told me that she had two prior admissions at other hospitals for similar symptoms. Following each admission, she had been treated with IV antibiotics and hospitalized for a week.
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