FCEM2-1069

FCEM2-1069

You evaluate a 72-year-old woman with a painful swollen left big toe. The pain started this morning and is described as the most severe pain she has ever experienced. It has gradually worsened over the past 8 hours. She is unable to wear socks or shoes and had to come to the appointment in open-toe sandals. The overlying skin is red and shiny.

She has a history of hypertension, which has been challenging to control. She is currently taking amlodipine 10 mg and ramipril 10 mg per day for this and is awaiting a review of her antihypertensive medication. Her blood pressure today is 165/94 mmHg.

She has recently also been diagnosed with a myelodysplastic syndrome and requires regular blood transfusions. She is being monitored in a local hematology clinic for a low white cell count and thrombocytopenia.

What is the most appropriate next step in management for this patient?