A 57-Year-Old Man With Difficulty Walking

Stephen Johnson, MD, MS; Michael Furman, MD, MS

Disclosures

September 16, 2015

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.

Background

A 57-year-old man presents to his primary care provider with gradually worsening lower-extremity pain and fatigue with ambulation. He is able to walk one block and then must sit down and rest owing to "tiredness" in his legs. He has intermittent low back pain, which rarely radiates into his left anterior thigh.

His medical history includes type 1 diabetes mellitus, hypertension, and chronic obstructive pulmonary disease. Current medications include insulin glargine (Lantus®), lisinopril (Zestril®), aspirin (Bayer®), and a fluticasone propionate inhaler (Flovent®). He smokes one pack of cigarettes per day, with a 20–pack-year history. He does not drink alcohol or use illicit drugs.

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