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Consultant Vol 44 No 4

Redness, irritation, and diplopia developed
over 2 to 3 weeks in a 55-yearold
man’s left eye (A). The injection
worsened and was unresponsive to
eye drops. Ptosis, mild proptosis, and
elevated intraocular pressure developed.
A bruit was auscultated over
the affected eye.

A 39-year-old man complains of severe daily headaches that he describes as throbbing and "burning," with a sensation
of pressure. He rates the severity of his pain as 8 to 10 on a 10-point visual analog scale (VAS) in which 10 is
the most severe. The mean duration of the headaches is 12 hours, and the mean frequency is 5 days per week. Between
the episodes of severe headache, he has constant "minor" headaches that are not as severe (mean severity, 3 to 5 on a
10-point VAS). Within the past 5 months, he has never been totally free of headache.

Four months after a patchy, macular,
erythematous spot erupted on the
dorsum of a 63-year-old woman’s left
foot, the area became ulcerated,
tender, and painful. The 1.2-cm ulcer
was covered by a hemorrhagic crust
surrounded by a cyanotic reticular
discoloration of the skin.

A 57-year-old man with a history of venous stasis leg ulceration
wondered about the “white spots” on his leg. The
condition is atrophie blanche, which manifests as smooth,
ivory-white macules and plaques of sclerosis stippled with
telangiectasia that often are surrounded by mild to moderate
pigmentation.

Sudden pain and a pulsatile swelling
of the right upper medial thigh concerned
an 80-year-old woman (A).
Coronary angioplasty had been performed
through this site 5 weeks
earlier.

A 70-year-old man who had just completed
a course of trimethoprim-sulfamethoxazole
for a urinary tract infection
presented with palpable purpura
and cutaneous erosions of acute onset
on his legs (A). He also had massive
scrotal edema and purpura (B).

A 52-year-old man complains of nausea, fever, and malaise following a 2-day diarrheal
illness that developed at the end of a family vacation in New England.
Two family members suffered a similar illness, characterized by watery diarrhea.
Symptoms developed in all who were affected within 24 hours of eating
hamburgers at a local restaurant.

Painful blue toes developed in a 72-year-old woman with coronary artery and
peripheral vascular disease after she underwent angiography.

A 16-year-old girl was bothered by
ankle pain and “red spots” on her
lower legs. These symptoms cleared
in a few days without treatment. Six
weeks later, after returning from an
all-day outing at a fair, she noticed
that the spots had reappeared (A)
and hemorrhagic lesions had developed
on the right ankle (B) and left
heel (C). After removing her shoes,
the teenager felt severe pain in both
ankles, particularly the right.

Except for those on the face, sutures
left in a few extra days pose little extra
risk and are less likely to result in dehiscence.

 
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