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Source: AusDoc website; 18 Jul to 11 Aug.
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Dr Liz Fraser GP in Canberra, ACT.
JEN, aged 67, enjoys an active retirement. A former health professional, she focuses on improving her health as she ages, and is physically active— hiking, gardening and swimming. Jen has a background of Graves’ disease, in remission for 10 years. She is a lifelong non-smoker who takes no medications. She consumes a wholefood low carbohydrate diet. For the past few years, one of her great pleasures is a weekly bushwalk, often combined with a cold water dip during the cooler months. Jen is perplexed when, five days after a day procedure that required a short general anaesthetic, she develops widespread aches and pains, similar to her previous experiences of post-exercise delayed onset muscle soreness. This is odd as she has not done anything sufficiently vigorous to account for this. There is no associated fever or malaise and Jen initially suspects that the discomfort might be related to the general
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anaesthetic or being moved around the theatre while unconscious. However, over the next week, her symptoms progress and she develops a blotchy red plaque-like rash over her breasts, abdomen and thighs( see figure 1). Around day seven post-procedure, she develops what appears to be thrombophlebitis in the greater saphenous veins of both thighs( see figure 2). Alarmed, Jen consults with her GP.
On examination Jen is afebrile, her BP is 115 / 70mmHg and heart rate 62bpm and regular. She weighs 69kg with a BMI of 23. She is afebrile, with extensive erythema and marked red, tender thickening along both greater saphenous veins. An urgent ultrasound shows inflammation in the subcutaneous fat of the thighs. Reassuringly, there is no superficial or deep venous thrombosis.
Jen mentions that a few days after the procedure, she went on a short bushwalk and dipped in water that was around 8 ° C for 10 minutes or so. This is not unusual for Jen. The symptoms developed two days after this, in a distribution consistent with the body parts that were exposed to cold water, and sparing Jen’ s shoulders, neck and head, which were not submerged. The GP and Jen suspect this unusual presentation may be cold panniculitis, which is expected to resolve with time.
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Discussion
Skin and subcutaneous adipose tissue have multiple functions, including protection from mechanical injury, insulation
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