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