Consulted to see in-patient 41 y/o AA female admitted by medicine team for newly diagnosed Lupus with concern for acute vasculitic changes to lower extremity and multiple other complicating issues.  She has no prior medical history and has not been in the hospital before.

On exam the patient has palpable pulses at the ankle, but cool, ischemia toes 1,2,3 L foot only.  She has significant pain to her L forefoot not relieved by narcotics.

Vascular surgery already consulted and detailed workup including angiogram have been performed with no planned intervention.

All indicators seem to point to acute changes secondary to vasculitis.  Any treatment / supportive ideas for this case instead of just watching while the forefoot demarkates?

 

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