Digital Ulcers + HIT
Today we went to the bedside to see a 49 yo F with limited scleroderma, who presented with digital ulcers. She initially presented with pain and ulceration that was refractory to supportive treatment at home, and shortly thereafter was admitted. The ulcer was most likely exacerbated by the presence of calcinosis at that digit.
Treatment for digital ulcers is done via vasodilators. This patient had failed a trial of sildenafil and was then started on epoprostenol (Flolan) with better effects.
Here is a short review on digital ulcers:
Rheumatology (2009) 48 (suppl 3):iii19-iii24.
Our second case was a patient with suspected heparin-induced thrombocytopenia (HIT). As we have all seen in practice, many patients have other reasons than HIT for reduction in their platelets. In order to best capture patients that truly have HIT, the 4T score is commonly used and is described in the oft-cited paper below.