A 60-year old policeman complained of chronic fatigue, aching joints, and painful burning sensation for several months in his lower extremity. Additionally, he witnessed small purple/red hemorrhagic spots only a week before. He reported that he had undergone a blood transfusion after a gunshot injury to his arm 35 years ago. He also reported distal paresthesia (tingling or numbness) of both legs and painful burning in both feet, which gradually progressed to his lower and upper limbs.
Frequent knee pain kept him waking up at night. Vitals Heart rate: 83/min Blood pressure: 114/72 mmHg Temperature: 37.8°C Oxygen saturation: 97% Normal Heart Sounds All pulses present Clinical examination The patient looked tired. Had no pallor Livedo reticularis (a mottled reticulated vascular pattern which often appears as a lace-like purplish discoloration of the skin) was observed in the patient.…
