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An Old Woman With a Very Different Purple Toe

An Old Woman With a Very Different Purple Toe

HISTORY

A 77-year-old woman on the behavioral health hospital unit for treatment of complications of dementia is seen urgently because nursing staff note blue second toe on right foot. Has had aortic problems including a resection of a segment with a free flap of atheroma, temporally associated with cognitive decline. Has atrial fibrillation and is on aspirin monotherapy with no warfarin.

PHYSICAL EXAMINATION

Lethargic woman who cannot give cohesive answers to our queries. No skin lesions elsewhere including no livedo reticularis. Left dorsalis pedis pulse palpable; right barely palpable (feeble); neither foot is cold to the touch; both are nontender. Sole shows islands of similar purple discoloration. The purple toe is blanchable when capillary refill is tested. Attempt at Doppler assessment of perfusion is impaired by technical malfunction.

"WHAT'S YOUR DIAGNOSIS?"

Answer on Next Page

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