2015-2016 Academic Year Archives - Dermatology Grand Rounds

54 year old man with multiple sores

May 27, 2016

Presenter: Mike Garone DO, Natalie Steinhoff DO, Jessie Perkins DO

Dermatology Program: NSUCOM/Largo Medical Center

CHIEF COMPLAINT: Multiple “sores” on the left hand, chest, and right neck

CLINICAL HISTORY: A 54-year-old man presents with multiple “sores” on his left hand, chest, and right neck. His clinical history reveals no signs of fevers, chills, night sweats, or unexplained weight loss. He denies experiencing nasal congestion, sore throat, epistaxis, mucosal erosions, nausea, vomiting, diarrhea, hematochezia, or melena. There is no reported history of immunodeficiency or HIV. However, he does report chest congestion and rhinorrhea occurring every morning, although he denies any prior history of allergic rhinitis. The patient’s past medical history includes hypothyroidism, and he has a negative surgical history. His family history is notable for a father with prostate cancer. Socially, he works as a government-contracted pilot, making frequent trips to the Middle East. He consumes alcohol socially but denies tobacco use or illicit drug use. His current medication includes Levothyroxine, and he has no known drug allergies. Three months prior to this presentation, the patient was in Iraq, where he experienced insect bites. He reports that some of these bug bites never healed. Initially, he was treated by his primary care physician with permethrin and triamcinolone 0.1% topical cream. Subsequently, he was treated with systemic azithromycin and pimecrolimus topical.

Painful rash in 15 year-old female

May 27, 2016

Presenter: Leslie Mills, DO

Dermatology Program: West Palm Hospital/PBCGME

CHIEF COMPLAINT: Painful rash involving her face, neck, and ears

CLINICAL HISTORY: A 15-year-old female presented to the Emergency Department with a painful rash affecting her face, neck, and ears. Four days prior to admission, after returning from Georgia, she experienced tenderness and pressure in her facial area, which progressed to significant edema, particularly in the periorbital region. The rash initially appeared as intensely pruritic, erythematous papules and vesicles that rapidly ulcerated, producing clear-yellow drainage. The patient reported associated ocular pain but denied experiencing oral lesions, fever, or chills. She also had no recent trauma, sick contacts, or exposure to animals, nor had she engaged in outdoor activities or used new products.

Pruritic rash with proximal muscle weakness

April 27, 2016

Presenter: Duggan C., Jajou P.

Dermatology Program: Beaumont Hospital Trenton

CHIEF COMPLAINT: Pruritic spreading rash

CLINICAL HISTORY: The patient is a 64-year-old female with hypertension, hyperlipidemia, hypercholesterolemia, hypothyroid, and depression who presented to the clinic with a pruritic rash that started on her left wrist and then spread to her right arm, chest, scalp, and posterior neck. She denied any recent sun exposure. The patient admits to some difficulty arising from a seated position as well as fatigue while combing her hair. The patient had been given multiple topical steroids with only minimal relief of the rash and the associated pruritus. Lab work, muscle, and skin biopsy were ordered, as well as follow up with rheumatology in regards to a muscle biopsy. The patient had been to multiple physicians prior to coming to our clinic including an internal medicine physician, dermatologist, allergist, rheumatologist, as well as her primary care physician. The patient admits having all normal screening exams such as a mammogram/colonoscopy/pelvic examination as well as a recent CT of her chest, abdomen, and pelvis which didn’t reveal any abnormalities.

Burning and stinging red nodules on the dorsum of hands

April 27, 2016

Presenter: Jessica Vincent, DO

Dermatology Program: OhioHealth O’bleness Hospital

CHIEF COMPLAINT: Burning and stinging red nodules on the dorsum of his hands x 1 year

CLINICAL HISTORY: A 57-year-old male presented to the current authors complaining of burning and stinging red nodules on the dorsum of his hands for about 1 year. He also admitted to the persistence of an episodic rash over the lower legs and bilateral flanks he had originally presented with 7 years prior. He was briefly treated with an oral prednisone taper and topical corticosteroids including triamcinolone 0.1% cream and clobetasol 0.05% cream without improvement. A biopsy 7 years prior revealed leukocytoclastic vasculitis (LCV) with prominent eosinophils. At the time, it was felt his skin findings were a manifestation of drug hypersensitivity, likely to opioid use. The patient was subsequently lost to follow up.

A 40 year old female with left sided facial swelling and lip swelling

February 27, 2016

Presenter: Huyenlan Nguyen, DO, Elise Grgurich, DO

Dermatology Program: Lehigh Valley Health Network/PCOM

CHIEF COMPLAINT: Left-sided facial swelling and lip swelling

CLINICAL HISTORY: A 40-year-old female with left-sided facial swelling and lip swelling. The most recent episode occurred one month ago and was associated with swelling of the face and lips. She feels the self-limited flares are related to stress and denies any associated new medications or provoking foods. She occasionally has numbness on the left side of her face that she attributes to her history of Bell’s palsy. She was treated with a course of prednisone and responded well.