Misdiagnosed in the ER :(

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Hi,

About three weeks ago, I banged my right big toe HARD. I mean REAL HARD! I don't even remember what I banged it on. Probably a box of canned goods we had around the house (from all of the HURRICANES we had down here in S. Florida!!)

It didn't hurt at first. But after a day or two, it was thorobbing, swollen, hard to walk on- etc etc. I figured it was just badly bruised. So I waited a few more days (kept walking on it). Uh oh- now I can't fit my shoe over my foot- even more pain & swelling. My leg is perpetually being elevated for the swelling.

So I take off a few days from work. The foot keeps getting worse. Now I can't even touch my toe to the ground. I notice that my foot (especially my right toe/joint area) is RED, HOT and EXTERMELY painful to the touch. I can't even touch it without wincing in pain!

Ok- time to go to the ER. I can't take the pain anymore. I am convinced it is broken! I get there and they give me a wheelchair to sit in. They finally take x-rays. The x-rays are normal. The doctor tells me that I have Cellulitis. The nurse comes in and gives me a HUGE shot of antibiotic. That hurt like hell! Then they prescribe Keflex for 10 days 3x day.

Ok- long story short- I am on this antibiotic for a good 7 days- I still go to sleep with pain & wake up with pain :( . I have no real improvement. As a follow up to the ER, I go to my Podiatrist. He takes one look at my foot and says it's not Cellulitis.

I have GOUT! He puts me on Indomethacin 3x daily. Low & behold within 3 days- my foot shows MIRACULOUS improvement! WOW! I just wish I had the indomethacin to begin with. It would have saved me so much pain and anguish.

Is this typical to be misdiagnosed for things like this case?

Thanks,

Julie :)

As you described your s/s, the first thing I thought was gout. But I already knew you were misdiagnosed b/c you said so. ;)

I think it would be very easy to misdiagnose you - you are a 36 y/o female, which is not typical for gout, plus you have a history of recent trauma to the area.

The index for suspicion was raised when you had no improvement with time or treatment with abx.

Hope you keep on feeling better!

Just wanted to add, situations like yours are a good example of the reason ERs always tell people to follow up with PCP/specialist/etc, b/c things may not be as they seem in the long run what they seem to be in the ER.

:)

you have my sympathy...i have chronic gout and sometimes if flares up acute..real bummer..glad you are doing better

Specializes in Maternal - Child Health.

Please understand that I'm not trying to be a flame-thrower here, but I suspect that your choice of the ER for care may have contributed to your mis-diagnosis. ER personnel practice with the mindset of caring for patients with acute injuries and illnesses, not patients with internal medicine-type problems. (Although they certainly see their fair share of that too.) They examined you, reviewed your labs and X-rays, and came up with what they believed to be the proper diagnosis, based on their mindset. I wonder if you had been seen in a family practice office or internal medicine office if the proper diagnosis would have been reached sooner, because of a different mindset on the part of the practitioner.

I know how frustrating this is, but please don't be too hard on the doc who treated you in the ER. S/he did not know you and was relying on the data at hand. Remember, docs are trained to "think horses" when they hear hoofbeats. Your case was a "zebra", and a clear indication as ERNurse752 states, of why follow-up is so important.

Hope you're feeling better.

Please understand that I'm not trying to be a flame-thrower here, but I suspect that your choice of the ER for care may have contributed to your mis-diagnosis. ER personnel practice with the mindset of caring for patients with acute injuries and illnesses, not patients with internal medicine-type problems. (Although they certainly see their fair share of that too.) They examined you, reviewed your labs and X-rays, and came up with what they believed to be the proper diagnosis, based on their mindset. I wonder if you had been seen in a family practice office or internal medicine office if the proper diagnosis would have been reached sooner, because of a different mindset on the part of the practitioner.

I know how frustrating this is, but please don't be too hard on the doc who treated you in the ER. S/he did not know you and was relying on the data at hand. Remember, docs are trained to "think horses" when they hear hoofbeats. Your case was a "zebra", and a clear indication as ERNurse752 states, of why follow-up is so important.

Hope you're feeling better.

Naw- I appreciate the care I received at the ER. I honestly thought my foot/toe was broken. That's why I went to the ER. I was in AGONY!!!

In any case- they DID say to follow up with my primary care- which I did (actually a podatrist). That's when I got the proper diagnosis. It sucks that so may patients use the ER as their primary care "physcians".

Specializes in 6 years of ER fun, med/surg, blah, blah.

OMG, it's so wonderful to actually have someone follow up with a Doc, & not just return to the ED. Gout is often hard to dx, esp. when you had a recent injury to that area. Hope you feel better soon.

Was the gout diagnosis confirmed with a blood test?

I once took care of a pt on a medicine unit who was there for three days because nobody could figure out whether she had cellulitis or gout and they weren't letting her go until they knew. I suspect that the two dxes are frequently mixed up.

I imagine they are mixed up. Especially since the primary sxs are "red, hot, and swollen". Sounds like both to me.

Specializes in NICU.

It would be interesting to know whether the podiatrist's first impression would have been cellulitis or gout if you had gone there first? He had a bit of an edge since he had the knowledge that several days of abx hadn't helped.

Additionally, isn't cellulitis a "riskier" situation, thus inducing the ER to treat for the more serious dx?

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