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What causes swelling and inflammation below the knee despite no blood clots being present?

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Posted on Fri, 27 Nov 2020
Question: The front of my right leg, from the knee down, is swollen and very red. It goes all of the way down through my foot. It is very tight and has started looking "splotchy". I am seeing a doctor but he is not sure what it is. I have had an ultra-sound done to check for blood clots which was normal...no clots and good circulation the doctor said. I have also had a CT scan with contrast and the radiologist that read the report said either cellulitis or venous insufficiency disease. The doctor has treated me with a very strong antibiotic but it has not made a difference that we can see. Sometimes it is painful enough that I can't stand for a sheet to even touch it. Other times it isn't as painful. It does feel fevered. Oh yes, the doctor has done a lot of blood work and it is all within normal range. The doctor has requested a "deep-tissue ultra-sound" which has been scheduled for next Tuesday. They told us that is the first appointment available. The doctor we go to is part of Watson Clinic in XXXXXXX Florida. Due to a family emergency my husband and I are going to have to go to XXXXXXX which is about a seven hour drive. We don't know exactly when but we are waiting on the call to go. Any ideas on what I can ask the doctor to check for and also do you have any ideas to keep my leg from getting worse from the long drive? I know it is very difficult to diagnose something online but at this point we are "clutching at straws". I forgot to tell you this has been going on for several months. Thank you for any assistance you can give me.
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Answered by Dr. Ornela Ademovi (3 hours later)
Brief Answer:

Picture needed

Detailed Answer:

Hello,

This sounds like a very interesting and difficult case indeed, since the most probable causes have been ruled out.

It is even more puzzling since all blood work haven't shown anything.

It could be a dermatological problem and a skin biopsy comes to mind and the next step, in case the deep tissue US doesn't give an answer.

However, I would need to see a picture to get a better idea of what I should be looking for.

As for your trip, avoiding long immobilization of the leg would be a good start. Try to move about as much as and whenever possible.

Hope I have answered your query. Let me know if I can assist you further.
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Ornela Ademovi (5 hours later)
Hi, I have provided some attachments. Please review them.
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Answered by Dr. Ornela Ademovi (35 hours later)
Brief Answer:

Cellulitis

Detailed Answer:

Hello,

Thank you for sending the images. I have reviewed them carefully and in my opinion it Cellulitis.

The rash and the swelling is typical. In my opinion, the reason Clindamycin didn't work is that it was not the right antibiotic.

I recommend you do an antibiotic sensitivity test and go for an initial intravenous dose. This should bring relief within the first 24 hours.

Hope I have answered your query.

Take care

Regards,
Dr Ornela Ademovi, General & Family Physician
Above answer was peer-reviewed by : Dr. Kampana
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Answered by
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Dr. Ornela Ademovi

General & Family Physician

Practicing since :2004

Answered : 732 Questions

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What causes swelling and inflammation below the knee despite no blood clots being present?

Brief Answer: Picture needed Detailed Answer: Hello, This sounds like a very interesting and difficult case indeed, since the most probable causes have been ruled out. It is even more puzzling since all blood work haven't shown anything. It could be a dermatological problem and a skin biopsy comes to mind and the next step, in case the deep tissue US doesn't give an answer. However, I would need to see a picture to get a better idea of what I should be looking for. As for your trip, avoiding long immobilization of the leg would be a good start. Try to move about as much as and whenever possible. Hope I have answered your query. Let me know if I can assist you further.