A 61-Year-Old Woman With Leg Ulcers

Marc Hare, MD


December 02, 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.


A 61-year-old woman presents to the wound center for continued treatment of venous leg ulcers complicated by diabetes mellitus. Her medical history is remarkable for essential hypertension and obesity.

The patient also has a history of angioimmunoblastic lymphadenopathy, which occurred over 15 years ago. The patient cannot remember any details of this diagnosis; consultation with her primary care clinician reveals that this was a benign/peripheral presentation. No records are available for review. According to the primary care clinician, the condition went into complete remission after a course of prednisone.

The patient notes that she has developed new wounds on both of her thighs. The lesions are black, with surrounding redness and tenderness. She reports no itching. She states that the lesions have been enlarging slowly over the past several days, and many are now several centimeters in diameter.

The patient denies having any fever or chills. Her fasting serum glucose readings have been stable in the range of 100-200 mg/dL. She denies experiencing any easy bruising or bleeding. She has not had any recent trauma or procedures in the area of the lesions, and she has not had any recent changes in her medications. She has no history of smoking or alcohol or illicit drug use.


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