Age: 61.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Skin fissures, Skin ulcer, Soft tissue swelling, Swelling, Weight bearing difficulty
Clinical narrative: 62 yo with PMH of lintellectual disability [lives with son who also has an intellectual  disability], T2 NIDDM,  Obesity, Db neuropathy, COPD/asthma, daily marijuana use,  Sept 2021 lung nodule eval'd by Dr--was to get bx but unknown if occurred. She presents after being referred by an Urgent Treatment Clinic to come to the ED for an infected right 2nd toe.    She has had toe redness, swelling,  and pain when bearing weight x 1 month.  Her son expressed a few purulent drops from the distal toe.  She denies fevers, sweats, chills, weakness, malaise, N/V/D, abd pain, dysuria, ShOB, cough, CP, palpitations,  HA, or syncope. She has mostly been bed and  chair ridden the past few days d/t wt bearing pain.  Her son has been helping her more.   She denies prior foot infections or foot surgeries though her record indicates "Db foot" and they are poor historians often going off on tangents of unrelated topics.   Her son reports that she always has dry, cracked soles of feet .  She has not recently been hospitalized or treated w/ any antibx.   The pt does not check her glucoses at home and is uncertain of what an A1C is.      In the ED, she is afebrile with stable VS;   BPs a little soft at times.  She is nontoxic-appearing, is talkative, and moves around on bed without problems. Labs:  No leukocytosis, hemoglobin 11.4, BUN/creatinine 25/1.2 (none to compare), glucose 180, bicarb slightly low 24.   CRP 2.1, ESR 22.   Imaging:     Distal Right foot XR:"Soft tissue swelling of the right 2nd toe with cortex erosion of the tuft of the distal phalanx concerning for osteomyelitis. "  Dr has spoken to Dr who will consult re: if surgical intervention needed.  Hospital has been asked to admit the patient.  DISCHARGE DATE 01232022:    Patient is a 62-year-old woman with a history of intellectual disability, DMII c/b neuropathy, and asthma who presented to the ED due to worsening redness and pain in her right 2nd toe.      Patient had reportedly presented to an urgent treatment center on the day of admission and was instructed to present to the ED due to concern for complicated toe infection.  Patient had reportedly had worsening swelling and redness in her toe for approximately one month prior to admission.  She had associated ulcer at the tip of her toe with some purulent drainage.  The patient was concerned that her foot return to gangrene and thus decided to seek medical attention.    Upon arrival to the ED, patient was noted to have stable vital signs.  Admission lab work was largely unremarkable.  She did have mildly elevated inflammatory markers.  She did incidentally test positive for COVID.  She had x-ray of her foot which was concerning for soft tissue swelling in the right 2nd toe with some cortical bone erosion at the distal phalanx concerning for osteomyelitis.  General Surgery was consulted in the ED.  Hospitalist was then contacted for admission.      Given her stability and no systemic signs of infection, systemic antibiotics were held on admission.  General Surgery evaluated patient and determined that they would prefer to start patient on PO antibiotics and follow her up as an outpatient.  Case was discussed briefly with ID it was determined that she could be discharged on a 2 week course of PO Augmentin and PO doxycycline and have close follow-up.  Patient was instructed to follow up with PCP, General Surgery, and ID in the outpatient settings to ensure that her toe infection continues to improve.    Patient did not have any symptoms consistent with COVID-19.  Suspect that she has an asymptomatic infection at this time.  Patient was instructed to isolate at home for 5 days after her initial positive test and to adhere strictly to mask adherence for an additional 5 days after finishing quarantine.