A 48 year-old male with history of borderline diabetes mellitus presents with chief complaint of left forearm pain and swelling with redness. He reports the pain and redness came on insidiously over the past 4 days and has been getting progressively worse. The patient states he thinks a spider bit him. He became more concerned when he noticed the redness on his arm was spreading over the last 24 hours. He denies having any fevers or chills. He denies any trauma to the area that he can remember. He denies any current or prior history of IV drug use. He denies taking any prescription medications. The patient works as a warehouseman in a shipyard.
Vital signs are stable. On exam the patient appears nontoxic and in no acute distress. Examination of his left proximal forearm reveals a 5x3 cm ovoid area of warm tender erythema and swelling. No fluctuance or crepitus are appreciated. He his able to fully range his left elbow without any pain.
Vital signs are stable. On exam the patient appears nontoxic and in no acute distress. Examination of his left proximal forearm reveals a 5x3 cm ovoid area of warm tender erythema and swelling. No fluctuance or crepitus are appreciated. He his able to fully range his left elbow without any pain.
A CT scan with contrast of the left forearm was obtained.
What is the diagnosis?
How would you manage this patient?
The diagnosis for this case will be posted in approximately 1 week.
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