What Is It Wednesday

Happy Hump Day everyone! Each Wednesday I will post wound photos and explain the diagnosis and treatment plan that set these patients on a path to healing. Sometimes physicians need to dig deeper into a patient’s medical history to fully understand their symptoms and put the puzzle back together.

It’s been exactly a year since I got a call from one of the local wound centers asking me to see this 70 year old man because they thought he had “gangrene.” He had undergone several venous ablation procedures and each time that he had an injection for an ablation, a new lesion developed. This one was circumferential, as was another lesion on the other leg. Does this look like a venous ulcer to you?

Wound - 2.4 - WITW

Here is his leg a year later. The black discoloration in the original photo was a terrible Pseudomonas infection. He has pyoderma gangrenosum, of course and rheumatoid arthritis. He’s been treated with Methotrexate and ORENCIA® (abatacept). He has diabetes. We even managed to heal his diabetic foot ulcer. It worries me that he had been SEVERAL times to the vein center for procedures on his legs and no one there said, “Hey, this doesn’t seem like a typical venous ulcer.”

Wound - 2.4 - WITW2