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A man in his 50s presented with a two week history of a large ecchymosis on his left ankle and foot, and a two month history of petechial rash on his lower limbs (fig 1 and fig 2). He had no history of recent trauma, fevers, night sweats, weight loss, or upper respiratory symptoms, and did not report any bleeding from other sites. His diet largely consisted of ready meals and he had not consumed fresh fruit or vegetables for more than a year. Fig 1 Large ecchymosis over patient’s left ankle and foot, with hyperkeratosis of skin overlying dorsal and lateral aspects of the foot. Multiple perifollicular haemorrhages on medial aspect of patient’s right lower leg Fig 2 Perifollicular haemorrhages surrounding prominent hyperkeratotic follicles with multiple corkscrew hairs on patient’s right lower leg (black arrows) He said that he had not used alcohol or injected drugs in the past six …

A 63-year-old woman presents to the medical receiving unit with a 2-month history of violaceous haemorrhagic nodules on her right lower leg on the background of 10-year history of chronic lymphoedema ([figure 1][1]). She had a complex medical history including previous deep venous thrombosis (DVT)

The greatest challenge in diagnosing vasculitis is the diversity of its clinical presentation. Awareness of the heterogeneity of uncommon manifestations can be decisive for the course of the disease. We report on a patient presenting with periostitis as the initial manifestation of systemic vasculitis. A 38 year old female patient complained about progressively painful swelling and reddening of the distal right lower leg for several weeks. The patient had been healthy until then and had no history of arterial or venous insufficiency. She presented at hospital with reduced pulses and a severe compartment syndrome of the tibialis anterior compartment. An x ray examination showed typical signs of periostitis …

The cases are reported of three off road cyclists with isolated soft tissue injuries to the right lower leg, caused by the chain ring as they struggled to release their feet from clipless pedals. Correct adjustment of the pedals to facilitate quick release of the feet is required to prevent such injuries.

A 79-year-old female, presented to accident and emergency with a painful right leg from the knee distally, after tripping. On examination, her right lower leg had a haematoma on the anterolateral aspect which was very tender. After 4 days, the patient was taken to theatre for debridement, and the wound was washed out. The next day, the wound was reconstructed with a split skin graft.

Your senior house officer visited a 74 year old man in the emergency department. He shows you a photograph of his right lower leg taken after he had examined it (figure). The man's lower right leg We are …

Three months ago my patient had a rash on his right lower leg, which was treated initially as fungal without effect, but cleared rapidly after treatment for allergy. Two months ago, he had severe stabbing pains “like glass digging in” on his left inner arm and right shin. These pains got worse, especially at night, and became agonising. One month ago his hands and feet blew up, became red, and subsided with a scaly rash; there was a preceeding sore throat and a raised antistreptolysin O test. He had seen various doctors over the months and had now come to me. His medical history included syphilis in the distant past; numerous negative results for VDRL …