Acta Dermato-Venereologica 98-7CompleteContent | Page 26

719 Painful Erythematous-violaceous Toe: A Quiz Sarah VENTEJOU 1 , Marion DELAPLACE 1 , Philippe DEHAYES 2 , Elodie BAILLY 3 and Laurent MACHET 1,4 * 1 Department of Dermatology, CHRU, Tours, 2 General Practitioner, Loches, 3 Department of Nephrolology, and 4 Department of Dermatology, University of Tours, France. *E-mail: [email protected] A 68-year-old woman was referred for specialized nail consultation in January 2018 due to a painful toe that had developed 2 months previously (Fig. 1). Pain had developed after walking for 2 h in the countryside, and a blister was seen on the toe in the evening, which the patient thought was a mechanical blister. However, the evolution was unusual, with persistent pain and discoloration of the affected toe. The general practitioner suspected infection and treated with oral antibiotics (pristinamycin, 2 g/day), with no ef- fect. Subsequent treatment with colchicine, 1 mg/day, did not alleviate the symptoms. Doppler examination of the Fig. 1. (a) Close-up of erythematous-violaceous 5 th left toe with nail dystrophy. (b and c) Mild erythrocyanosis affecting toes of both feet. lower-limb arteries was normal. Radiography of the affected toe did not reveal osteitis. The patient had a history of arterial hypertension treated with perindopril, 5 mg/day, for 2 years and with enalapril, 10 mg/day, and lercanidipine, 10 mg/day, for 3 months. She had never smoked. Skin examination revealed red-bluish discoloration of the distal part of the 5 th left toe, with nail dystrophy. Palpation was painful, but there was no increase in skin temperature and no sign of skin or joint infection. Other nails on the hands and feet were normal. Erythrocyanosis was present in other toes, notably the right 5 th toe. Discoloration tem- porarily disappeared with friction of the skin. The remaining skin examination, including hands, was normal. There was no Raynaud’s phenomenon. Blood pressure after 15 min rest was 164/72 mmHg, heart rate 90 bpm, temperature 36.8°C, and body mass index 20 kg/m 2 . Results of routine blood tests, including C-reactive protein (CRP) and uric acid, were within the normal range, except for mild renal insufficiency (creatinine level 107 µmol/l, clearance 46 ml/ min) and elevated thrombocyte count, 619 g/l (normal <400 g/l). Tests for antinuclear and antiphospholipid antibodies were negative. What is your diagnosis? See next page for answer. QUIZ SECTION This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2018 Acta Dermato-Venereologica. doi: 10.2340/00015555-2953 Acta Derm Venereol 2018; 98: 719–720