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The patient was subsequently diagnosed with vasculitis by muscle biopsy
on 12-12-02 and continued to have worsening problems with patchy ischemia.
Testing was negative for ANA, ANCA, RF and he was presumed to have polyarteritis nodosa. He was started on steroids and Cytoxan therapy for immunosupression,
but he continued to lose weight. Additional studies for vascular disease
found that the patient was heterozygous for Factor V Leiden. He was admitted
to the hospital on 8-16-03 with dry gangrene of the left great toe and
severe abdominal pain.
1. What is polyarteritis nodosa?
2. What additional risks does Factor V Leiden impose on this patient?
3. Review the EKG from this admission; are there any signs of cardiac
ischemia?
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EKG |
4 . An x-ray of the foot was performed to rule out osteomylitis of the great
toe, do you see any bone loss?
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X-ray of the foot |
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