WSI23-111-Case-20

WSI23-111-Case-20

Case #20 - The patient is a female above the age of 89 with a history notable for atrial fibrillation on warfarin, heart failure with preserved ejection fraction (65%), hypertension, coronary artery disease, hypertension, hyperlipidemia, and peripheral vascular disease status post right and left below-the-knee amputations in the past 3 years. She presents with chest pain, transient aphasia, and mottling and pain of the right below-the-knee amputation site. Relevant laboratory results: Creatinine 0.54 mg/dL (reference interval 0.6-1.50 mg/dL), calcium 8.6 mg/dL (reference interval 8.5-10.5 mg/dL), phosphate 1.8 mg/dL (reference interval 2.6-4.5 mg/dL). PTH was not determined. On exam, the right extremity was cool to the touch with mottling and dusky discoloration and with an ulcer on the right below-the-knee amputation site (see clinical photograph #20). A revision surgery is performed and the involved skin sampled for histologic evaluation.

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December 31, 1969 7:00:00 PM