M.S., a 55-year-old woman, presents to the diabetes clinic with an ulcer 2 cm wide × 1 cm deep on…

M.S., a 55-year-old woman, presents to the diabetes clinic with an ulcer 2 cm wide × 1 cm deep on the left lateral aspect of her foot that she first noted a month ago. Her primary-care physician had prescribed a 2-week course of ciprofloxacin and gave her instructions for regular wound care. A few days before her clinic visit, the callus surrounding the ulcer cracked open and a small piece of bone protruded from the wound. She reports mild swelling and redness but denies any pain, fever, or chills. Her past medical history includes type 2 diabetes mellitus, hypertension, peripheral neuropathy, and chronic kidney disease requiring hemodialysis three times a week. Laboratory findings include a WBC of 5,200 cells/?L with normal differential, BUN of 56 mg/dL, serum creatinine of 5.6 mg/dL, fasting blood glucose of 240 mg/dL, hemoglobin A1c (Hgb A1c) of 12.4%, and ESR of 45 mm/hour. What findings in M.S. are consistent with secondary osteomyelitis?

 

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