Discolored, Painful Toes in a 43-Year-Old Woman

Colin C. Edgerton, MD

Disclosures

September 03, 2015

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.

Background

A 43-year-old woman presents to the rheumatology clinic with a 1-month history of painful, discolored toes. She first noted redness and itching at the tips of her toes about 2 months before presentation. The itching progressed to tenderness, followed by the formation of "sores" over the affected areas. She notes that the toes have been sensitive to cold, particularly when she leaves the house and is exposed to winter weather. She denies any trauma to her feet, recent illnesses, or surgical interventions.

The patient has never had similar symptoms in the past. She feels otherwise well and denies any fever, joint pain, gastrointestinal symptoms, or weight changes. Her current medications include over-the-counter fish oil tablets and a daily multivitamin. She does not smoke tobacco and drinks three glasses of wine weekly.

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