Check out our latest endocrine case report from Brady Pregerson, MD, which features a 53-year-old male with a history of obesity, DM on glucophage, and HTN on Lasix. Can you determine the correct diagnosis?
History of Present Illness:
A pleasant 53-year-old male with a history of obesity, DM on glucophage, and HTN on Lasix presents to the ER with one month of migratory bilateral ankle pain, currently worse on the left. He has seen many doctors, had x-rays and been prescribed orthotics, but no one is sure of the cause and he has not been able to work for the past two weeks due to severe worsening pain. He denies any fever, injury, increase in activity prior to symptom onset, calf swelling, chest pain, shortness of breath, or other complaints.
Vitals & Physical Exam:
Vital signs are normal except for a blood pressure of 172/98. His physical exam is normal except for some mild bilateral ankle tenderness. He is quite obese, so you cannot really tell if the ankles are swollen or just fat, but they look symmetric. There is no redness. There seems to be slight warmth on the left, compared to the right ankle.
1. What does the case image show?
2. What should you do next?