Ankle Injury Results in Fatal Infection

Case Overview

This case takes place in Vermont and involves a patient who presented to hospital shortly after a fall that resulted in an injury to her ankle. Following evaluation, it was determined that she had suffered a small fracture, and it was noted that the patient had redness on her leg at that time. Nevertheless, the patient was placed in a cast and was given crutches. The patient fainted shortly thereafter and was kept in the hospital for observation. During her stay at the hospital, the patient’s vital signs began to deteriorate, and it was also noted that she had a red line running up her leg that was consistent with a serious infection. The following day the patient went into cardiac arrest and died. It was later revealed that she had a severe bacterial infection.

Questions to the Internal Medicine expert and their responses

How often do you treat patients with this presentation?

In ID, we routinely consult on Grp A cellulitis -- necrotizing fasciitis is an infrequent but severe and predictable complication of these infections, including in the post-trauma setting.

What is the standard work up for these patients?

These infections require a high index of suspicion with prompt surgical consultation / intervention, as well as appropriate antibiotic therapy promptly provided.

Could you review the medical records and opine on your findings?

The cast can sometimes mask close clinical observation, but one must maintain vigilance particularly if vitals are unstable or there are other signs of multi-organ involvement.

About the expert

This highly qualified expert is board certified for Internal Medicine, Infectious Disease and Preventive Medicine. He is a member of Infectious Diseases Society of America as wekk as American College of Epidemiology. He has received several honors and awards including but not limited to American Cancer Society, Physician Training Award in Preventive Medicine, American Society of Microbiology, George McCracken Infectious Disease Fellow Award and NIH Fellow's Award for Research Excellence. Currently, he is an Associate Professor of epidemiology/infectious disease at a major medical center.