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Necrotizing Angiitis? Idiopathic Vascular Thrombosis? Presented by Joseph Rapaport, MD.
The patient is a 33-year-old white man with a history of leg and foot ulcerations since 1960. At first he had ulcers around the ankles which required skin grafts and then in April 1966, a posttraumatic ulcer of the left big toe appeared which required two months to heal under topical therapy. In February 1967, the present ulceration of the left fifth toe began and has gradually progressed, in spite of vigorous topical therapy.The patient smoked a pack of cigarettes a day. In September 1962, he had a posterior myocardial infarct, and in November 1962, he was hospitalized for left hydronephrosis due to a renal calculus.Physical examination revealed gangrenous ulceration of the periungual area of the left fifth toe with livedo of the distal portions of the toes of the left foot. The skin temperature was normal to
Linden IH, Carney JW, Williamson C, Ayres S. THE LOS ANGELES DERMATOLOGICAL SOCIETY. Arch Dermatol. 1967;96(5):600-602. doi:10.1001/archderm.1967.01610050122021