Endocrine Case Report: Vaginal Bleed in a Patient with Diabetes

Our latest emergency department case report from Brady Pregerson, MD, features a woman in her 60s with a history of diabetes presenting for post-menopausal vaginal bleeding. Can you determine the correct diagnosis?

History:

A female in her 60’s with a history of diabetes comes to the emergency department for post-menopausal vaginal bleeding, about 2 pads/day, and lower abdominal “pressure”. She denies vomiting, fever, diarrhea or other symptoms. She recently had a UTI and is still on Bactrim but takes no blood thinners.

Exam:

Pulse 108, BP 104/58, Temp 98.8. Large pannus that appears a bit pink but she is dark skinned so color assessment is more challenging. Possibly swollen mons pubis but difficult to tell due to obese body habitus. With a chaperoned genital exam it is noted that the right labia major ulcer oozing blood from a small ulcer.

Testing:

  • WBC = 22 with 9% bands
  • Glucose 305, bicarb 26, albumin 2.3
  • Pelvic ultrasound was normal for a post-menopausal woman

What is the most likely diagnosis?