Diagnosing Repeated Lower Extremity Ulcerations

Guest Clinical Editor: Tamara Fishman, DPM

A patient’s medical history can provide you with critical information that is necessary to differentiate among the various types of lower extremity ulcerations. Not only are there many different etiologies of lower extremity ulcers, it’s also important to be aware of the patient’s underlying medical conditions as well, as you will see in the following case study.
A 38-year-old Caucasian female patient recounted her underlying medical conditions when she came in for evaluation and treatment of her left leg ulceration. She injured the side of her leg while walking and had the ulceration for about a month. She noted that she has had ulcers in this area in the past.
The patient says the last time she had the same exact ulceration, it took a little over a year to heal. Her past medical history is significant for osteoporosis, rheumatoid arthritis, microcytic anemia and lower extremity edema. She also noted that she had many blood transfusions when she was in her 20s.
This patient is young and very active, which makes it difficult for her to remain off her feet. She explained that the more swelling she has in the lower limb, the more pain she feels.

What Is The Diagnosis?
1. Sickle cell anemia
2. Rheumatoid arthritis
3. Thalassemia
4. Pyoderma gangrenosum

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