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A 68 year old diabetic was admitted with a history of vomiting and feeling unwell. He was found to be pyrexial and tachycardic. He had brawny discolouration of the skin in the right forearm and right leg. He was noted to have crepitus in the right forearm and right shin. No obvious external wounds could be seen. There was no history of trauma. His creatine phosphokinase was found to be elevated at 13 220 IU/l. He had radiographs of the right leg and forearm (figs 1, 2). Later he became hypotensive and lost pulses in the right leg and left forearm. He was treated with antibiotics and intravenous fluids.
What is the differential diagnosis? What emergency procedure would you perform?
See page 993 for answer
This case is submitted by:
Robin Spiller, Editor