Chronic Non-Healing Leg Ulcer Complicated by Sepsis: A Case of Peripheral Vascular Disease and Wound Management

A 62-year-old male presents to the emergency room with lethargy and fever. He is noted to have a leukocytosis of 21,000/mm3, lactic acid elevation, low-grade tachycardia and fever but otherwise normal vital signs. He is determined to have clinical evidence of sepsis. The workup of the source of sepsis is negative aside from an open skin ulcer on the medial side of his left lower leg. He reports the area has been open for two months now and started as an abrasion from a new cowboy boot which he had worn to a hoe down without high socks. Upon further questioning, the patient’s wife admits the wound has been weeping more fluid lately. On exam, the wound is foul-smelling, surrounded by erythema and is hot to touch. It has a thick, foul-smelling purulent discharge, and the wound is without fluctuance. Also notice that the hair is missing from most of his lower legs bilaterally. The patient’s wife reports his hair has been scant on his legs for a few years.