2010-2011 Academic Year Archives - Page 2 of 3

Rash in nursing home patient

November 26, 2010

Presenter: Panagiotis Mitropoulos DO, Justin Rubin DO, Lise Brown DO, Stanley Skopit DO

Dermatology Program: NSU-COM/BGMC

CHIEF COMPLAINT: Rash on buttocks for several months

CLINICAL HISTORY: An 84-year-old Caucasian woman, nursing home resident, with a seven-month history of erythematous, mildly pruritic, non-tender rash involving the right buttock area. Patient was being treated by a primary care physician with ketoconazole cream without significant improvement of symptoms.

Enlarging erythematous plaque with multiple draining sinus tracts

October 26, 2010

Presenter: Ryan Jawitz, DO

Dermatology Program: St. Joseph Mercy Hospital

CHIEF COMPLAINT: “Rash on the right hand”

CLINICAL HISTORY: A 78-year-old male presented with a 2-month history of an erythematous plaque on his right hand that started after gardening. The plaque was non-pruritic and non-painful but has been draining a purulent discharge for the last six weeks. His medical history included diabetes mellitus type 2, coronary artery disease, chronic obstructive pulmonary disease, hypertension, prostate cancer, and laryngeal cancer treated with radiation. The plaque was treated as cellulitis with both oral and IV antibiotics for the prior two months, however, it continued to enlarge.

Persistent and progressive hyperpigmented patches

September 26, 2010

Presenter: Angela Bookout, DO; Lana McKinley, DO; Khonnie Wongkittiroch, DO

Dermatology Program: Largo Medical Center/ NOVA Southeastern University COM

CHIEF COMPLAINT: “Darkening of the skin for four years”

CLINICAL HISTORY: A 33-year-old Indian male complained of progressive darkening of his skin beginning on his neck, spreading to his face, and eventually involving both arms over the past 4 years. No previous treatments. He has no significant past medical history and no known drug allergies. He denied using oral medications or topical preparations during the past five years. He reported only incidental sun exposure. Review of systems was negative for pain, xerosis, pruritus, dermatitis, alopecia, nail changes, or other systemic symptoms.

Painful, erythematous-violaceous plaques across the abdomen

August 26, 2010

Presenter: Betsy Leveritt, DO

Dermatology Program: Wellington Regional Medical Center

CHIEF COMPLAINT: diffuse painful plaques

CLINICAL HISTORY: A 52-year-old Caucasian male with a past medical history of liver cirrhosis, subsequent hepatorenal syndrome, and end-stage renal disease (ESRD) on hemodialysis (HD), presented with a several month histories of numerous painful, erythematous-violaceous plaques across the abdomen and bilateral thighs and upper extremities, accompanied by necrotic erosions of the lower extremities. A review of systems revealed low-grade fevers with occasional chills, night sweats, and a significant weight loss of at least 13.6 kg over the preceding 3-4 months. During prior hospital admission, the patient manifested these same skin lesions, and was given a 3-month course of intravenous antibiotics for a biopsy-proven Actinomyces infection. He also recalled being given Heparin during that same hospital stay.

Rash in hospitalized patient

July 26, 2010

Presenter: Jonathan Richey, DO, Monica Nafsou, DO

Dermatology Program: Pontiac/Botsford Osteopathic Hospital

CHIEF COMPLAINT: “Red, painful rash on butt and armpits”

CLINICAL HISTORY: A 44-year-old Caucasian male with a history of lower extremity osteomyelitis was treated with Unasyn and Vancomycin following below the knee amputation. The patient had no prior medical history, largely due to inadequate health maintenance. He had a 20-pack year history of smoking. On the eighth day of treatment with antibiotics after amputation, the patient developed a “rash.” The patient described the lesions as “very painful” – the worst areas being the right axilla and sacral area.