Geriatric Concerns-A Photo Essay

A 76-year-old man who was a nursing home resident was seen because of redness below the right eye. A close-up view shows periocular swelling and erythema confined to the inferior area, sparing the upper lid. The conjunctiva is free of vascular dilation or erythema and of chemosis. No proptosis is present. Localized redness about the right orbit, centered on the lower lid, permits a diagnosis of preseptal cellulitis.

Image courtesy of Henry Schneiderman, MD.

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A man in his 70’s came to the ED after 5 days of slurred speech. He had difficulty in swallowing and chewing and had been using his hand to hold his jaw closed. Phonation seemed weak and a bit nasal. Based on symptoms of bilateral cranial nerve weakness in an older man without other symptoms, myasthenia gravis was the diagnosis. Almost one-third of cases present in the older population.

Images courtesy of Brady Pregerson, MD.

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An 88-year-old woman sought care for a nodule on the anterior surface of her left foreleg that had developed gradually. An exophytic nodule with ulceration and some element of surface hyperkeratosis in a geriatric patient is almost always malignant. A biopsy in this case disclosed well-differentiated but deeply invasive squamous cell carcinoma.

Image courtesy of Ted Rosen, MD.

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Nursing staff noted a blue second toe on the right foot of a 77-year-old woman being treated for complications of dementia. She had had aortic problems and atrial fibrillation. Manual separation emphasizes dissemination of irregular purple discoloration onto the sole just proximal to the blue toe. Prominent warty keratosis is seen on the inferior surface of the second toe and keratinous debris on the third toe and in a 1-cm deep “trench” just before the smaller toes separate. The diagnosis: atheromatous embolism.

Image courtesy of Henry Schneiderman, MD and Alexander Mbewe, MD.

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An 88-year-old man presented with a non-healing ulcer on his right lower limb. The lesions started as multiple red nodules and became ulcerated and painful. He had extensive necrotic ulceration of his shin, covered by black hemorrhagic crust. A 3-mm punch biopsy showed “benign ulceration”; an arteriogram showed calcification of the profunda femoris and superficial femoral arteries. His condition, calciphylaxis, is most often found with chronic renal disease and secondary hyperparathyroidism.

Image courtesy of Dedee F Murrell, MA, BMBCh, FAAD, MD and Laura Baillie, BSc, MBBS.

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