#may2020amc1
A 75-year-old man is admitted to the vascular surgery ward with a pale, cold and painful right foot. The pain is worse on elevation of the foot. Four weeks ago he was commenced on prednisolone 15 mg daily by his General Practitioner for polymyalgia rheumatica. He is also complaining of a headache in the right temporal area and some pain on chewing. He has not had any visual disturbance. On examination foot pulses on the right are absent, the popliteal artery pulse is diminished when compared to the left.
CRP: 102 mg/L.
Haemoglobin: 124 g/L.
White cell count: 10.4 x109g/L.
Platelets: 450 x109g/L.
Renal and liver function are normal. He has never smoked and is not diabetic. Which one is the following is the most likely diagnosis?
A. Deep vein thrombosis
B. Arterial thrombus in the femoral artery
C. Atherosclerotic arterial disease
D. Buerger's disease
E. Large vessel vasculitis
Explanatory Notes:
The headache and jaw claudication on a background of PMR with a high CRP are highly suggestive of temporal arteritis. This large vessel vasculitis can affect any large artery. Ischaemic changes in limbs is rare but it is important to appreciate that limb or digital ischaemia with none of the usual risk factors for peripheral vascular disease should prompt consideration for more unusual causes.
A 75-year-old man is admitted to the vascular surgery ward with a pale, cold and painful right foot. The pain is worse on elevation of the foot. Four weeks ago he was commenced on prednisolone 15 mg daily by his General Practitioner for polymyalgia rheumatica. He is also complaining of a headache in the right temporal area and some pain on chewing. He has not had any visual disturbance. On examination foot pulses on the right are absent, the popliteal artery pulse is diminished when compared to the left.
CRP: 102 mg/L.
Haemoglobin: 124 g/L.
White cell count: 10.4 x109g/L.
Platelets: 450 x109g/L.
Renal and liver function are normal. He has never smoked and is not diabetic. Which one is the following is the most likely diagnosis?
A. Deep vein thrombosis
B. Arterial thrombus in the femoral artery
C. Atherosclerotic arterial disease
D. Buerger's disease
E. Large vessel vasculitis
Explanatory Notes:
The headache and jaw claudication on a background of PMR with a high CRP are highly suggestive of temporal arteritis. This large vessel vasculitis can affect any large artery. Ischaemic changes in limbs is rare but it is important to appreciate that limb or digital ischaemia with none of the usual risk factors for peripheral vascular disease should prompt consideration for more unusual causes.
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