The latest endocrine case report from Brady Pregerson, MD, features a man in his 60s with diabetes and left below-knee amputation for a smelly right foot that has been getting gradually worse for 2 weeks. Check out the report, labs, and imaging and see if you can determine the correct diagnosis.
History of Present Illness:
A man in his 60’s with a history of DM and left BKA is brought to the hospital by his wife for a pink smelly right foot that has been getting gradually worse for the past 2 weeks. He did not want to see a doctor but the smell got so bad that his wife finally called 911. He denies any fever, recent trauma or other complaints though he says he broke the same foot a long time ago in a motorcycle accident.
Vital Signs & Physical Exam:
Vital signs are normal except for a pulse of 118. The temperature is 99.1. Physical exam is otherwise normal except for a BKA on the opposite leg and a stinky erythematous right foot with a large black eschar.
Initial Diagnostic Testing:
Labs: Glucose 350, bicarb is normal, lactate 2.5, creatinine 2.1, WBC 32K, 12 bands
What is the most appropriate diagnosis?