Case Presentation

A 52 year-old female with type 2 diabetes of 10-year durationwas admitted with worsening of shooting pain and swellingof her lower extremities over the previous nine days. Thepain was rated 10/10 in severity, was worse in the right side ascompared to the left, radiated from her lower legs to thighs, andlimited her mobility for the previous five days. She reportedno history of trauma, fever, chills, skin changes, or medicationnoncompliance. She was managing her diabetes with twoinjections of premixed insulin. Her other medical problemsinclude a history of congestive heart failure with an ejectionfraction of 45%, coronary artery disease, stage 4 chronic kidneydisease, and hypertension. A review of systems was remarkablefor exertional dyspnea and mild ascites.