A 28-Year-Old Man from Ghana With a Chronic Ulcer on His Ankle

Clinical Presentation

History

A 28-year-old West African man presents to a clinic in Ghana complaining of a painful ulcer on his left ankle. The ulcer has been present for the past 4 months and is not healing ( Fig. 62.1 ). There is no history of prior trauma; however, he had a previous ulcer on his right ankle some years ago which took about a year to heal. He also complains of pain in his right thigh and in both knees.

Fig. 62.1, The patient’s left leg showing an ulcer surrounded by hyperpigmented skin on the medial malleolus.

Clinical Findings

The patient is short for an adult; he is pale and has a tinge of jaundice. The ulcer is on his left ankle, next to the medial malleolus; the skin surrounding it is hyperpigmented. There is tenderness in both knee joints and in his right thigh. The rest of the physical examination is normal. Vital signs: Temperature 36.6°C, pulse 88 bpm, blood pressure 110/70 mmHg.

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