Doppler ultrasonography of her left leg two weeks prior had yielded normal results. Past medical history is significant for ankylosing spondylitis, hypertension, and hypothyroidism. Medications include propanolol, levothyroxine, conjugated estrogen, medroxyprogesterone acetate, ferrous sulfate, flurbiprofen, and calcium supplements. The patient is alert, appears pale and anxious, and is in moderate discomfort from pain in her left leg. Her left leg is tender to palpation without crepitus.
Pitting edema extends the entire length of the leg with a reddish- blue discoloration.
3- 5 cm hemorrhagic bullae on the medial thigh. See figure 1. The patient also complained of a burning-itching like pain in her left leg with palpation. Neurological exam is normal in the extremity. Pulses are normal in the affected leg, however capillary refill time is three seconds.