What's Your Diagnosis

An obese woman in her thirties with a history of fibromyalgia syndrome, depression, polycystic ovarian syndrome, and diabetes mellitus presents to her local emergency department with 1 week of gradually worsening midline back pain.

Episodes of lost balance, "wiggling" eyes, a family history of consulsions: does this toddler have epilepsy, or is something else going on?

Medication is seldom necessary. Education is the key element of therapy. An explanation of the process and a discussion of possible triggers—lack of sleep, stress, missed meals etc—is the most key intervention.

This patient had unilateral petechiae on the dorsum of the left foot. If the petechiae were symmetric, the first condition on the differential diagnosis would be thrombocytopenia. Here, though, the platelet count was normal. The patient also had a duplex of both the arterial and venous systems that showed complete thrombosis of both the arterial AND venous systems.

The patient has a stage 1 decubitus ulcer on her left heel. Both feet are cool but are the same temperature. Distal pulses are palpable but weak on the good foot; they are not palpable on the left and can only be heard faintly with a hand-held Doppler. You note unilateral petechiae on the dorsum of the left foot.