Footprints

A 42-year-old woman with a history of asthma and the irritable bowel syndrome presented with pain and swelling of her feet and ankles that were associated with a rash on her lower extremities. A 42-year-old woman presented with pain and swelling of her feet and ankles that were associated with a rash on her lower extremities. Foreword In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage A 42-year-old woman with a history of asthma and the irritable bowel syndrome presented with pain and swelling of her feet and ankles that were associated with a rash on her lower extremities. A few days earlier, the patient had awakened with an achy sensation in her feet, and the pain had progressed since then. She reported having difficulty in walking and noted she was “shuffling” to get from place to place. She had “painful red bumps” over her lower extremities. The rash, which was nonpruritic, started at the dorsum of the foot, extended over the malleoli bilaterally, and . . .