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Woman with a hand ulcer.
Paul E Stromberg1, Jennifer Y Montgomery, Timothy C Evans
1Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, Richmond, VA 23298-0522, USA. pstromberg@mcvh-vcu.edu
Clinical Toxicology (Philadelphia, Pa.)
|March 1, 2012
Summary
A chronic headache patient developed a severe hand ulcer with exposed bone. This case highlights potential links between analgesic overuse and severe soft tissue complications.
Area of Science:
- Dermatology
- Vascular Surgery
- Pain Management
Background:
- A 20-year-old female with chronic severe headaches requiring daily analgesics presented with a hand wound.
- The patient reported the ulcer onset approximately 10 months prior to seeking medical attention.
Observation:
- Examination revealed a large (10 cm x 8 cm) ulceration on the dorsum of the left hand.
- The ulcer exhibited exposed and necrotic metacarpals, fibrous exudate, and a foul odor.
- Initial laboratory results showed a normal white blood cell count, C-reactive protein, and erythrocyte sedimentation rate.
Findings:
- The case presents a severe, chronic hand ulcer with significant tissue necrosis.
- The etiology of the ulcer remains unclear but is potentially linked to the patient's history of chronic pain and analgesic use.
Implications:
- This case underscores the importance of investigating chronic wounds in patients with complex medical histories.
- Further investigation is warranted to determine the underlying cause and optimize treatment for such severe soft tissue injuries.
- Consideration of medication side effects in the differential diagnosis of chronic, non-healing wounds is crucial.
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