Case Reviews: Vasculitis of the Foot & Ankle
● Introduction to Vasculitis of the Foot and Leg MPN introduced Dr. Mariyam Abbasi, an attending surgeon at the Brooklyn Hospital Center, who presented a case on vasculitis of the foot and leg. Dr. Abbasi stated the importance of reviewing rare cases like this for podiatrists to be aware of and properly diagnose conditions beyond typical presentations such as heel pain or Achilles tendinosis (00:04:28).● Case Presentation and Diagnosis of IgA Vasculitis Dr. Mariyam Abbasi described the case of a 15-year-old male presenting with a palpable purpuric rash on their bilateral feet and lower extremities, associated with severe gastric pain, vomiting, extreme weakness, and nausea (00:04:28). Initial differentials included allergic reactions and thrombocytopenia, but the concomitant symptoms and lab results (including hematuria/proteinuria and elevated ESR/CRP) led to the diagnosis of Henoch-Schönlein Purpura (HSP), also known as IgA vasculitis (00:05:33). Dr. Abbasi noted that this small blood vessel vasculitis is IgA mediated, with IgA complexes depositing in blood vessels, which explains the skin, kidney, and GI tract manifestations (00:08:37).● Clinical Course and Treatment The patient had a previous history of a minor URI one month prior and unfortunately developed kidney involvement. Dr. Mariyam Abbasi noted that the patient was treated with a 30-day tapered course of 20 mg of prednisone, but the rash continued to spread, requiring them to be put back on prednisone for an extended 15 days until the rash resolved and the urine sample was negative. The disease is typically self-limiting, but some patients like this one develop complications, requiring a pediatric nephrologist consultation; the discussion also touched on different types of vasculitis like large, medium, and small vessel types for educational context (00:05:33) (00:09:58).● Vasculitis in Podiatry and Treatment Options Dr. Mariyam Abbasi shared another case of Kawasaki disease in a 13-month-old baby who initially presented with red, swollen feet and a purpuric rash, emphasizing the need to consider zebras (rare diagnoses) alongside horses (common diagnoses) (00:11:48). Treatment options for IgA vasculitis include high-dose steroids, though recurrence is possible in 50% of young kids, and IVIG is another popular treatment for autoimmune conditions like this (00:14:05).● Importance of Consultations and Networking Dr. Reem Sheikh highlighted the value of discussing rare scenarios like vasculitis for board exams and clinical practice, stressing the need to always order correct tests and referrals to rule out possibilities, even for seemingly chronic wounds (00:15:13). Dr. Mariyam Abbasi and Dr. Reem Sheikh strongly agreed that practitioners should not hesitate to refer out, consult colleagues, or seek second opinions, particularly in pediatrics or complex cases, to avoid letting ego impede practice (00:17:11). A first-year student, asked how to go about seeking second opinions, to which Dr. Mariyam Abbasi explained that this is easier in a hospital setting with a multidisciplinary approach, while Dr. Reem Sheikh emphasized that networking with colleagues is built over time through school, rotations, and residency (00:18:42).
