A 37-year-old man presents for evaluation of “easy bruising” and “bleeding gums.” At the time of medical consultation, the smell of ethanol was detected on his breath.
Key point: As noted, bruising is a sign/symptom to be taken seriously. In this case, the combination of swollen and friable gums, along with bruising and the distinct odor of ethanol in the middle of the morning, suggested that the patient abused alcohol(Drug information on alcohol). As such, he might well be subject to nutritional deficiencies. His vitamin C level was 0.004 mg/dL (about one hundredth of the expected level), confirming the suspected diagnosis of scurvy. Bruising is one sign of this disorder.
Treatment: While alcohol dependence was being addressed, the patient received oral vitamin C supplementation and a diet high in fresh fruit.
Note: It is rare to find signs and symptoms of an isolated deficiency, and this patient was also at high risk for pellagra and beri beri.
A hematologically stable CML patient developed a solitary, exquisitely painful ulceration, 7 cm × 5 cm, located on the mid-medial foreleg. There was never any evidence of venous insufficiency. The patient denied the possibility of a spider bite. What is the likely cause of this lesion?
