REPORT OF A CASE
A 77-year-old man was admitted to Walter Reed Army Medical Center, Washington, DC, for evaluation and management of failure to thrive. Prior to his admission, the patient had been hospitalized at another institution for shortness of breath and dyspnea on exertion. Evaluation at that time revealed decompensated congestive heart failure, end-organ nephropathy attributed to his long-standing diabetes mellitus, osteomyelitis involving both feet, a monoclonal gammopathy, normochromic normocytic anemia, and evidence of malnutrition. Despite initiation of cardiac glycosides and diuretics, which minimized his cardiorespiratory problems, the patient continued to develop progressive weakness, anorexia, persistent dizziness, and severe limitations in ambulation, for which he was transferred to our institution.Physical examination revealed a cachectic, elderly, mentally alert man in moderate distress. Major findings included significant retinopathy, wet and dry rales at the base of both lung fields, an irregularly irregular cardiac rhythm, iliofemoral bruits, absence of ankle jerks
Slagel GA, Lupton GP. Postproctoscopic Periorbital Purpura. Arch Dermatol. 1986;122(4):465–466. doi:10.1001/archderm.1986.01660160121032
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