Clinical images: Necrosis at the tip of the nose in an 83-year-old man.

摘要

The patient, an 83-year-old man, was referred to us for management of necrosis at the tip of the nose that had been developing for 1 week despite triple-antibiotic therapy. An ophthalmologic examination a month prior, soon after the patient had begun experiencing ocular pain and progressive loss of visual acuity in the left eye, had showed central retinal artery occlusion. Physical examination revealed dry, painful necrosis at the tip of the nose (left), with neither fever nor cervical adenopathy, and only a very weak pulse was detected upon palpation of the left temporal artery. Laboratory analysis revealed leukocytosis (white blood cell count 14,000/mm~3) with neutrophilia, an erythrocyte sedimentation rate of 70 mm/hour, and a C-reactive protein level of 200 mg/liter; asymmetric left central retinal artery pulses were seen on ophthalmoscopy.