The treatment of hypertension should never be taken lightly. If you doubt it, a recent medical case published by the New England Journal of Medicine should finish convincing you. That of a 64 -year -old man who presented himself in the emergency room of Boston with an open and infected ankle wound.
A purulent wound dug in the ankle
The lesion, ulcerated, suppurative and smelly, stretched 8 cm long and 5 cm wide, with black edges and streaks of yellow pus. The story had started two years earlier, with simple pruriginous plates on the legs. And it was only five months before its hospitalization that a lesion on the left ankle degenerated into an open ulcer. But what happened to arrive at such an infection? (Images are available here but beware, these can be shocking.)
A heavy medical context
To find out, doctors reviewed the patient’s history who could have favored abscess. Originally from Korea and installed in the United States for two decades, the man worked in an automatic laundromat, standing more than eight hours a day. At his age, he suffered from several chronic conditions: eczema, type 2 diabetes, hypercholesterolemia, and above all, high blood pressure. If he had well received a prescription from Metformin, statins and two antihypertensors (hydrochlorothiazide and losartan), he recognized that he did not follow his treatment well.
The consequences were visible: its diabetes was “poorly controlled”, with an HBA1C at 11 %, and its blood pressure culminated at 215/100 mm Hg in the emergency room, an alarming level, well beyond the severe hypertension threshold.
The Martorell ulcer track
Despite the first hypotheses (diabetic ulcer, osteomyelitis, thrombosis, even cancer …), the exams ended up excluding most of the diagnoses. But an in -depth biopsy finally identified the real cause: a Ulcère de Martorell. A rare but formidable complication … chronic and uncontrolled high blood pressure.
Described for the first time in 1945, these ulcers were formed when high blood pressure damages small arteries under the skin, causing local ischemia, tissue necrosis, then ulceration. They are renowned for their intense pain and their frequent location on the lower legs.
Heavy treatment, preventable outcome
To be except, the patient had to undergo three surgical interventions to remove the dead tissues, followed by a skin transplant. He also received targeted antibiotics against two opportunistic bacteria identified in the ulcer. After an extended stay in the hospital, he was able to heal.
Tragic irony: doctors note that a simple compliance with the initial treatment against hypertension would probably have been enough to avoid all this medical spiral. When caregivers tried a more aggressive drug approach with four antihypertensivers, patient tension has dropped dangerously. Proof that his basic treatment, if he had been well followed, was actually adapted.
Hypertension: a silent, but avoidable threat
This spectacular case illustrates a reality that is too often ignored: high blood pressure is a bomb with silent delay. It damages the organs, stiffens blood vessels and can cause serious, painful and long to cure skin ulcers. However, it is easy to detect and generally well controllable with suitable treatment. The message is clear: not taking their antihypertensive drugs can have dramatic consequences. The story of this man, although tragic, ends well. But … she could simply have been avoided.
