A close relative (53yrs, female, hypertensive, no history of diabetes and tobacco) was admitted in ICU for 15 days due to severe viral pneumonia/ARDS. The pneumonia is now almost cured, but the patient has developed these gangrene like dead cells on her fingers. Most likely cause is a thrombus developed in wrist due to pic line used during pneumonia treatment. The vascular surgeons took a call to not take surgical intervention at that time due to severity of lung damage and started heparin. She is out of ICU for last 1 week, but still getting fever multiple times everyday. All the blood tests for bacterial infections are coming negative. The doctors at the hospital are saying that they will wait for sometime and then probably amputate the affected area. Is there any way to heal this without surgery? Also, could gangrene be cause of fever? Edit: I have attached the image of Doppler report. Also heparin is going on for last 20 days.

Case Study A 43 year-old woman presents w/ fatigue, malaise, pharyngitis & fever of 100.7°F that started 8 days ago after an abscess drainage from her gums. Now she has noticed these painless lesions shown on her hands and feet. During examination you also notice subungual hemorrhages of her fingers.Chest radiograph shows pulmonary infiltrates. During cardiac auscultation, you hear a murmur suggestive of tricuspid regurgitation that the patient denies having previously been knowledgeable of. What is the most appropriate diagnosis? a. Endocarditis b. Idiopathic thrombocytopenia purpura c. Peripheral arterial vascular disease d. Systemic lupus erythematosus e. Toxoplasmosis source: https://cme4life.com/case-study/cme4life-top-10-facebook-case-studies/

one and half yr old presented with fever for 10days and blackish discolouration of toes since 8days which is increasing. Liver just palpable and 1cm spleen. Pansystolic murmur on mitral area on auscultation. Discuss.

65 yr old women with prednisolone treated temporal arteritis since 1 year. On Alendonate ,calcium, vitamin D and magnesium tablets presented with 3 months pain and feeling cold in her feet and heels. no problems in her hands or fingers. worse in the evening. no paresthesias. On exam cold feets. normal pulses and redness. on further questioning similar episodes in the past but shorter peroids. exposure to cold while young. A suspected case of chillblaines ( perniosis). What are the differentials and what treatment option would you suggest here?

11,/f first time in this winter.diagnisus?needed test? treatment?