Man's Ghastly Festering Ulcer Stumps Doctors—Until They Cut Out a Wedge of Flesh
Freeman writes:
If you were looking for some motivation to follow your doctor's advice or remember to take your medicine, look no further than this grisly tale.
A 64-year-old man went to the emergency department of Brigham and Women's Hospital in Boston with a painful festering ulcer spreading on his left, very swollen ankle.
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The man told doctors it had all started two years prior, when dark, itchy lesions appeared in the area on his ankle-the doctors noted that there were multiple patches of these lesions on both his legs. But about five months before his visit to the emergency department, one of the lesions on his left ankle had progressed to an ulcer. It was circular, red, tender, and deep. He sought treatment and was prescribed antibiotics, which he took. But they didn't help.
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The ulcer grew. In fact, it seemed as though his leg was caving in as the flesh around it began rotting away. A month before the emergency room visit, the ulcer was a gaping wound that was already turning gray and black at the edges. It was now well into the category of being a chronic ulcer.In a Clinical Problem-Solving article published in the New England Journal of Medicine this week, doctors laid out what they did and thought as they worked to figure out what was causing the man's horrid sore.
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His diabetes was considered "poorly controlled."
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His blood pressure, meanwhile, was 215/100 mm Hg at the emergency department. For reference, readings higher than 130/80 mm Hg on either number are considered the first stage of high blood pressure.
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Given the patient's poorly controlled diabetes, a diabetic ulcer was initially suspected. But the patient didn't have any typical signs of diabetic neuropathy that are linked to ulcers.
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With a bunch of diagnostic dead ends piling up, the doctors broadened their view of possibilities, newly considering cancers, rare inflammatory conditions, and less common conditions affecting small blood vessels (as the MRI has shown the larger vessels were normal). This led them to the possibility of a Martorell's ulcer.
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