Painful, Patchy Pallor And Hyperemia In The Feet Of A Completive 16 Year-old Swimmer - Page #3
 

Lab Studies:
The following lab tests were normal: Complete metabolic profile (except mildly elevated AST at 48), complete blood count, alkaline phosphatase, calcium, albumin, CRP, TSH, ENA panel, ANA panel, anti- DS DNA normal, anticardiolipin, compliment tests, ANCA. Lupus anticoagulant was indeterminant.

Other Studies:
Non-invasive upper and lower limb arterial studies including pre/post exercise ankle brachial index. Popliteal artery entrapment maneuvers, erythromelalgia protocol were normal. All digits showed delayed rewarming following ice immersion, consistent with primary vasospasm (Pictures 6 & 7).

EMG, Thermoregulatory sweat test (Picture 8- to look for small fiber neuropathy), and autonomic reflex screen were normal. Tilt table test showed a tendency to orthostasis. CT Angiography and MRI of the knees performed elsewhere were normal (Picture 9).

Consultations:
Neurology
Vascular Medicine
Rheumatology

Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.


NOTE: For more information, please contact the AMSSM, 11639 Earnshaw, Overland Park, KS 66210, (913) 327-1415.
 

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