Quiz
Leg ulceration – 10 cases

This quiz tests your diagnostic skills for leg ulceration.

For each of the ten cases, study the image(s) and then answer the questions. You can click on the image to view a larger version if required.

Each case should take approximately 2 minutes to complete. There is a list of suggested further reading material at the end of the quiz.

When you finish the quiz, you can download a certificate.

Case 5

A patient in her 50's presents with very painful ulceration affecting both thighs and lower legs.

What is the diagnosis?

Calciphylaxis

What are the predisposing factors?

Calciphylaxis is associated with chronic renal failure, most often associated with diabetes and hyperparathyroidism. It is very rare in any other context. It tends to affect women more often than men, and is more likely in obesity or when corticosteroids have been prescribed. The pathogenesis is not yet fully elucidated.

What are the clinical features of this condition?

Painful angulated necrotic ulcers appear on the thighs and calves with surrounding blue-black ischaemia. The patient is not usually febrile. X-rays demonstrate subcutaneous calcification.

What investigations should be performed?

The patient is generally already under the care of a renal physician, who will check calcium, phosphate and parathyroid levels. A biopsy is usually performed to confirm the presence of intravascular calcification. Swabs should be taken because of the risk of secondary infection and because necrotising fasciitis may appear similar.

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Quiz Leg ulceration – 10 cases

Case 5

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Quiz
Leg ulceration – 10 cases