An Old Woman With a Very Different Purple Toe
The plantar aspect of this toe shows purple nonuniform darkening that mimicked either a simple traumatic hematoma or the blue toe syndrome. More proximally, however, the solar aspect contained irregular dark-purple dots reminiscent of individual thrombosed venules, and in addition showed discontinuous purple zones more proximally in the part of the ray that lay within the body of the foot and that surely could not be imputed to any possible toe trauma or fracture nor to ischemia in the distribution of any single vessel. No purple area was warm or tender.
HISTORY
A 77-year-old woman on the behavioral health hospital unit for treatment of complications of dementia is seen urgently because nursing staff note blue second toe on right foot. Has had aortic problems including a resection of a segment with a free flap of atheroma, temporally associated with cognitive decline. Has atrial fibrillation and is taking aspirin monotherapy with no warfarin.
PHYSICAL EXAMINATION
Lethargic woman who cannot give cohesive answers to our queries. No skin lesions elsewhere including no livedo reticularis. Left dorsalis pedis pulse palpable; right barely palpable (feeble); neither foot is cold to the touch; both are nontender. Sole shows islands of similar purple discoloration. The purple toe is blanchable when capillary refill is tested. Attempt at Doppler assessment of perfusion is impaired by technical malfunction.
"WHAT'S YOUR DIAGNOSIS?"
Answer on Next Page
ANSWER: A NEW FORM OF PURPLE TOE
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