Medical Mystery: The case of the painful purple spots

After years of getting painful ulcers on her feet, Emory Special Diagnostic Services solved Shelly Matheson's mystery

Top Doctors purple spots

Illustration by Chris Gash

When a little purple spot first appeared on Shelly Matheson’s ankle, it seemed like something curious that she would mention to her internist. Then, it got bigger and painful—and turned into an open ulcer. It healed, but other spots appeared and erupted into ulcers.

A dermatologist told Matheson, 54, that the purple spots were small blood clots beneath the skin. Thinking they might be caused by an autoimmune reaction, he sent her to a rheumatologist, who gave her anti-inflammatories. Over a period of more than seven years, she visited another dermatologist, a hematologist (blood specialist), a vascular surgeon, and a wound clinic.

Prednisone, a corticosteroid that suppresses the immune system, brought relief for about a year and a half. But then the spots came back with a vengeance. Ulcers appeared on both ankles, and redness streaked across her skin like it was on fire. She slept with ice packs on her ankles, wore compression stockings, and took pain medicine every four to six hours just to make it through the day.

At times the sores would subside, only to flare up again, often in the spring and summer. She tried medicines, dietary supplements, creams, and ointments, but she still had sores—and no diagnosis.

Matheson works as a supervisor of business operations at Emory Clinic administration, and when she heard of the Special Diagnostic Services clinic, she knew she had to go there. “This was my last bit of hope,” she says.

Diagnosis: Livedoid vasculopathy. Dr. Clyde Partin studied her voluminous records, and when Matheson came in, he delved into questions for more than an hour. After looking at new blood tests, Partin consulted with Dr. Robert Swerlick, head of dermatology at Emory Clinic. Swerlick is the one who gave her the diagnosis—a rare disease of the blood vessels in the lower legs and feet—and he put her on metformin and B vitamin supplements. She hasn’t had a single purple spot or ulcer since. “It was my miracle,” she says.

This mystery was solved by Emory Clinic’s Special Diagnostic Services. For more about the clinic and Dr. Clyde Partin, check out our story, Doctor Detective.

This article appears in our July 2018 issue.