New Clinical Problem-Solving: A Matter of Time 👉 nej.md/4ql7ehk A 29-year-old woman with active opioid, alcohol, benzodiazepine, tobacco, and cocaine use disorders and recent intravenous drug use presented with acute onset of chills and increased pain and drainage of chronic wounds in both legs. Her wounds first appeared more than a year before presentation and were attributed to xylazine exposure. She had not injected into the wounds or shared needles. She reported that she did not have fever, sweats, rigors, rash, cough, abdominal pain, or dysuria. The wounds in her legs were purulent, erythematous, and painful (seen in figure). She reported no additional medical history and took no medications. Her social history was notable for engaging in occasional unprotected transactional sex. The hemoglobin level was 8.7 g per deciliter with a mean corpuscular volume of 78.5 fl (both unchanged from 1 month earlier), white-cell count 4930 per cubic millimeter with 57% neutrophils and 31% lymphocytes, and platelet count 484,000 per cubic millimeter. The results of a complete metabolic panel were unremarkable. The erythrocyte sedimentation rate was 77 mm per hour, and the C-reactive protein level was 3.1 mg per deciliter. Given concern for SSTI, with possible underlying osteomyelitis, blood cultures were obtained and empirical antimicrobial therapy was initiated with vancomycin. Read the full case details in the Clinical Problem-Solving article “A Matter of Time” by G.A. Wilson et al., from @HopkinsMedicine: nej.md/4ql7ehk