Case Vignette

CIM Junior Clerks

Case Vignette
A 50-year-old female came in because of an ulcer in the left medial
malleolar area.

History revealed IM nailing and leg cast for 6 months secondary to left
femoral shaft fracture 5 years ago. This resulted in a brownish
discoloration and recurring edema of the foot and lower leg for
several years, which was managed with compression stockings and leg
elevation.

Three weeks prior to consultation, she scratched an itchy vesicular

lesion in the anterior lower leg which developed into the present skin
ulceration (Picture 1).
Picture 1
1. What is your
initial impression?
2. What other
considerations?
3. What diagnostic procedure or
test/examination do you need?
4. What is your management?
Picture 2