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JAMA Clinical Challenge
April 5, 2016

Postprocedural Blue Toes

Author Affiliations
  • 1Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City
  • 2Department of Dermatology and Pathology, University of Iowa Hospitals and Clinics, Iowa City

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2016;315(13):1396-1397. doi:10.1001/jama.2016.1810

A man in his 70s with a history of coronary artery disease, hypertension, and mild aortic stenosis presented with altered mental status, acute kidney injury requiring dialysis, and painful, dusky skin discoloration on his distal extremities. Three weeks prior, he had undergone coronary angiography and coronary artery bypass graft surgery after myocardial infarction. On physical examination, he had exquisitely tender blue macules, patches, and papules on the plantar aspect of several toes (Figure 1A) and red, tender macules on his hands (Figure 1B). Laboratory examination was notable for a white blood cell count of 9100/μL with 22% eosinophils, blood urea nitrogen level of 70 mg/dL (25 mmol/L), and creatinine level of 6.1 mg/dL (539.2 μmol/L). Urinalysis was remarkable for 1+ blood and 2+ protein.

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