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 that you would like to suggest for a future Case Challenge, please contact us.
A 70-year-old woman who has a history of chronic obstructive lung disease presents for an office visit with increased coughing and shortness of breath. In the past, she had smoked cigarettes regularly but quit 20 years ago. She does not have diabetes; however, she takes a diuretic for mild hypertension. Until a few days ago, she routinely walked her dog 2-3 miles a day. For the past 2 days, she has been coughing up green sputum. She does not recall any exposure to people with respiratory symptoms.
Examination reveals that the patient has a mild fever, normal blood pressure, and some increased rhonchi. A diagnosis of bronchitis is made, and oral levofloxacin 125 mg/d for 1 week is prescribed.
Six days later she returns to the office. Her bronchitis has improved, but she has developed pain above the right heel. A chest examination shows decreased rhonchi. She is advised to take the remaining levofloxacin and to reduce her activity. Diclofenac ointment is prescribed to be applied to the painful area around the right heel.
Two days later a telephone call confirms that the ointment has reduced the local pain and the bronchitis has resolved. However, 2 days after that phone call, the patient returns to the office with worsening pain above the heel. She now has a limp and tends to drag the right leg.
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Cite this: Anthony H. Woodward. Heel Pain and Limp in a Dog Owner Coughing Up Green Sputum - Medscape - Apr 19, 2023.