Rare Condition Diagnosed in Patient With Dry Gangrene, Limb Numbness
A 49-year-old white woman with seropositive rheumatoid arthritis presented to her Charlotte, NC rheumatologist with left foot dry gangrene. She had undergone joint resection in 2015 to correct a hammer toe. The patient’s recovery was difficult and complicated by left foot drop as well as residual numbness and weakness. This was initially attributed to an unexpected complication of regional anesthesia.
Given persistently poor wound healing over the next year, she was diagnosed with osteomyelitis and treated with antibiotics. She ultimately underwent a partial amputation of 2 toes on the left foot. Shortly after, she continued to have progression of ischemia of the left foot with worsening numbness as well as new bilateral wrist drop. Electromyography (EMG) revealed lack of response in 14 of 20 nerves in all 4 limbs, consistent with axonal and demyelinating injury. Her prednisone was increased to 60 mg daily by her local rheumatologist, and she was transferred to Duke in March.
Questions: What rare condition was diagnosed? What treatment was prescribed?