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This 56 year-old homeless, alcoholic male presented to your emergency department complaining of generalized malaise, diffuse bony aches and a rash to his lower extremities. The symptoms had been present for 2 weeks without any fever, chills or known sick contacts, and the rash was noticed 1 week ago and was progressing. It was nonpruritic, and the patient denied any traumatic event or prior history of a similar rash. The patient was malnourished but alert and oriented. His vital signs were stable. His exam was otherwise insignificant except for diffuse muscle/bony aches and a lower extremity rash (figures 1 and 2).  

Figure 1 (click on image to enlarge)
alt

Figure 2 (click on image to enlarge
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What are your concerns as you examine this patient?
Conclusion on next page

 

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# Urine 2010-10-01 13:24
Wow, what an interesting way to write the article. On page one I was guessing my heart out, trying to diagnose this person, but other than what looked like heavy internal bleeding, I could not diagnose anything. Scurvy - very interesting. Wonder if he will keep getting Vitamin C when he is back on the streets.
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