2002-2003 Academic Year Archives - Dermatology Grand Rounds

Two Brown Spots on the Left Hand

October 24, 2002

Presenter: Matthew Muellenhoff , DO, Thi Tran, DO, Frank Armstrong , DO, Kathleen Soe, DO, Greg Houck, DO, Marya Cassandra, DO

Dermatology Program: Sun Coast Hospital, NOVA Southeastern University Dermatology Program

CHIEF COMPLAINT: Two Brown Spots on the Left Hand

CLINICAL HISTORY: The patient reported a 5-year history of two brown spots on the left hand. Initially, the lesions were blue and attributed to ink stains although the patient denied contact with any staining chemicals or dyes. The “spots” increased in size over a two-year period and changed from blue to brown in color. She denied recent travel and had no history of skin cancer or atypical nevi. Family history revealed a brother with a history of melanoma. Her medications included premarin and glucosamine and she denied any allergies.

Pruritic Painful Groin Rash

September 29, 2002

Presenter: Laurie Schaeffer, D.O., Michael Eyre, D.O., Wendy McFalda, D.O., Cindy Lavery, D.O.

Dermatology Program: Pontiac Osteopathic Hospital

CHIEF COMPLAINT: Pruritic, painful groin rash for approximately six weeks

CLINICAL HISTORY: The patient experienced a painful, pruritic, and progressive rash located in the groin. The rash began on the sides of his scrotum and had steadily progressed to involve the entire scrotum, sides of the penis, and upper thighs. He had difficulty ambulating and washing the area due to the intense pain. He denied any dysuria, hematuria, or discharge. He could not recall similar outbreaks and denied any constitutional symptoms. He complained of occasional diarrhea.

Subcutaneous Nodules on the Face, Neck, and Upper Extremities

August 29, 2002

Presenter: Robert J. Zabel, DO

Dermatology Program: Philadelphia College of Osteopathic Medicine / Lehigh Valley Hospital

CHIEF COMPLAINT: Chest pain and shortness of breath

CLINICAL HISTORY: A 60-year-old Hispanic female with a two-year history of idiopathic crescentic glomerulonephritis presented with chest pain and shortness of breath. Cardiac ischemia was excluded from serial lab studies and intravenous heparin was started for a potential pulmonary embolism. On hospital day three, subcutaneous nodules were noted on her forehead. These nodules rapidly increased in size and number over a 24-48 hour period. They spread rapidly over the face, neck, upper trunk, and upper extremities. The subcutaneous nodules transitioned to exophytic and weeping lesions. On hospital day seven, she developed a productive cough with blood-tinged sputum and a chest radiograph showed diffuse bilateral infiltrates. A pulmonary angiogram was negative for an embolism and anticoagulation was stopped. A bronchoscopy revealed nodules lining the bronchi and diffuse alveolar hemorrhage.

Translucent and Hyperpigmented Papules and Nodules on the Upper Back and Neck

July 29, 2002

Presenter: Stephen Mallette DO, Alpesh Desai DO

Dermatology Program: Western University College of Osteopathic Medicine of the Pacific

CHIEF COMPLAINT: Painless papules on the upper back for three months, which are increasing in size and number.

CLINICAL HISTORY: The patient states that lesions are non-tender and have enlarged slowly over time. There is no pruritus or discharge from the lesions. They occur only on the upper back and neck. Topical steroids, topical antibiotic and oral antibiotics. The patient has been receiving dialysis since 1999 and has a fistula located on her left forearm. The patient moved to the United States from Nigeria in 1997.

Pruritic rash with alopecia

June 29, 2002

Presenter: Peter A. Vitulli, Jr. D.O., Steven Moreno, D.O., Eric Adelman, D.O.

Dermatology Program: Nova Southeastern University / North Broward Hospital District, Ft. Lauderdale, FL

CHIEF COMPLAINT: Pruritic Rash With Alopecia

CLINICAL HISTORY: A 78-year-old African American male presents to the dermatology clinic with a nine-year history of a progressively expanding, mildly pruritic rash on his neck and face. He reports that the eruption initially started on his neck and has since spread to involve his face. Additionally, he is experiencing progressive hair loss and a chronic cough, but he has not sought medical attention for these symptoms until now. His past medical history includes hypertension, and he has no significant past surgical history. He is allergic to penicillin. Family history is non-contributory, and socially, he lives with his wife and has two sons. He denies any use of tobacco or illicit drugs. In terms of previous treatment, he has not received any interventions for his skin condition. He is currently taking Adalat 30 mg daily for his hypertension.