Edited by Roxanne K. Young, Associate Editor.
You may have heard about J.D. on morning rounds: "Multiple medical problems:
diabetes with extensive peripheral vascular disease, chronic renal failure,
status post renal transplant, diffuse necrosis of distal extremities; acutely
presenting with poorly healing diabetic foot ulcer and cellulitis."
He was a challenge to care for, and his nephrologist—who had over
many years become his de facto primary care physician—had given up on
what to do about his vascular insufficiency and extremity necrosis, which
had already cost J.D. one leg. Having recalled the patient describe an episode
of frostbite some 30 years ago that maybe, just maybe, could have been Raynaud's
and a sentinel sign of some rare but treatable rheumatologic process, he turned
to his colleague—the medical student—to pursue this remote but
intriguing diagnostic question. He then disappeared.
Chris Hall. The Teaching Case. JAMA. 1998;279(14):1053. doi:10.1001/jama.279.14.1053