COW #1

A 30yo Mexican woman who recently gave birth to a healthy full-term infant is admitted to the hospital for a painful L breast mass that she has noted for the last 2 weeks. She notes redness and pain for one week, and newly draining purulent fluid for the last 3 days. After appropriate imaging, a diagnosis of mastitis with Staph bacterial superinfection is made and she is started on IV antibiotics. She is afebrile and doing well. A PPD is negative.

As you are admitting her and doing a review of systems, she tells you “Well, doc, this may not have anything to do with anything, but for the last 3 months, I’ve had a lot pain in my ankles. Sometimes they get real swollen and red. I’ve had it before, too; they started a couple of years ago.” She denies significant fevers or chills with these episodes. She states that they first started in her mid to late 20’s. As you examine her, you note bilateral ankle swelling, exquisite tenderness and mild warmth and erythema; you note a mild bilateral knee swelling, left greater than right; you also notice slightly raised, painful discolorations on her legs (see image).

 

A. What is the likely diagnosis (name the syndrome)?

B. What are the leg lesions?

C. What further lab(s) would you send?

Answers back to Gautam @ drdeshpande@gmail.com by Sunday 9/2/07 @ midnight! Good luck!