2015-2016 Academic Year Archives - Page 2 of 3

Seven year old male with full body eruption

December 27, 2015

Presenter: Trent Gay, DO

Dermatology Program: Lewis Gale Hospital Montgomery

CHIEF COMPLAINT: Full body eruption

CLINICAL HISTORY: A 70-year-old male presented with a 4-month history of an asymptomatic, scaly, persistent full-body rash. He reported no preceding infections or recent travel and is otherwise in good health. His past medical history was unremarkable, with no current medications, significant family history, or surgical history. The patient lives at home with his parents, denies alcohol or tobacco use, and attends elementary school. He has no known drug allergies. At the time of presentation, two punch biopsies were performed, and the patient was prescribed desonide ointment and Sarna lotion. The biopsy results revealed non-specific spongiotic dermatitis. One month later, the patient returned for a follow-up and was placed on an oral steroid taper. Although the rash resolved during the steroid treatment, it reappeared upon tapering and remained unresponsive to the previous topical medications. Consequently, two additional punch biopsies were performed. Following the results, the patient was started on oral erythromycin.

Long standing upper body rash

November 27, 2015

Presenter: Stephen Colden Cahill, DO, Stephanie Juliet Kang, DO

Dermatology Program: Tri-county Dermatology, Ohio

CHIEF COMPLAINT: Rash on the body

CLINICAL HISTORY: In August, a 37-year-old Caucasian female (Fitzpatrick skin type 2) with a past medical history of depression, DJD, and spinal stenosis, presented for consultation regarding a five year pruritic rash over her face, neck, chest, shoulders, and arms. She was seen one month ago by her primary care physician, who performed lab work which showed an elevated CRP 31.3 (normal 0-5mG/L), normal CBC w/diff and negative ANA. She was placed on a 7 day prednisone taper and OTC loratidine. Her symptoms had mild short term relief and then promptly returned. She reports suffering from similar lesions over the last five years which have waxed and waned in intensity. She denies any new recent medications or herbal supplement additions. She cannot specifically associate the lesions with sun exposure. She denies any systemic symptoms, other than low back pain which has been an ongoing issue for several years. She is an active one pack per day smoker and occasional social drinker, denies any illicit or recreational drug use.

Infection of the lower leg not responding to antimicrobial therapy

October 27, 2015

Presenter: Shannon McKeen, DO

Dermatology Program: MSUCOM/Lakeland Regional Medical Center

CHIEF COMPLAINT: Infection on the left ankle

CLINICAL HISTORY: A 9-year-old female presented for evaluation of an infection on the left ankle. The patient injured her leg on a rock in Mobile Bay several months ago while on vacation with her family in Alabama. The wound was cultured and the patient was empirically started on Cephalexin by her primary care physician with little improvement. Wound culture from the outside office showed rare Staphylococcus epidermidis susceptible to Trimethoprim-Sulfamethoxazole. The patient is up to date on her Tetanus and other immunizations. No recent travel out of the country. The patient was started on Trimethoprim-Sulfamethoxazole and referred to Dermatology.

Generalized rash in 33 year-old female

October 27, 2015

Presenter: Liza Brown, DO, Francisco Kerdel, MD

Dermatology Program: Larkin Community Hospital (LCH/NSU-COM)

CHIEF COMPLAINT: Generalized “rash”

CLINICAL HISTORY: The patient is a 33-year-old female with a past medical history significant for asthma and bipolar disorder, who presented to Larkin Hospital dermatology service as a direct transfer for a “generalized rash”. Upon questioning, the patient stated she was started on Lamictal July 13, 2015, for her bipolar disorder. Two weeks after starting Lamictal patient reported developing angioedema and went to an ER near her home. She was given epinephrine and IV steroids with mild relief and was discharged home at that time. August 2, 2015 patient went back to the ER after the development of new symptoms; a generalized targetoid rash that began cephalad and extended caudally. The patient was admitted for three days and then was transferred to Larkin Community Hospital on August 5, 2015, after she began having sloughing of skin and dysphagia. Complete review of systems was within normal limits other than mentioned previously. The patient denied previous drug allergies, other new medications, or recent travel.

Atrophic dermatosis on bilateral legs

August 27, 2015

Presenter: Jennifer Peterson DO, Angelo Petropolis MD, Amy Weierman PA-C

Dermatology Program: Advanced Desert Dermatology

CHIEF COMPLAINT: Odd blotchiness on legs

CLINICAL HISTORY: A 65-year-old Caucasian female presented for evaluation of odd blotchiness on her legs. The patient reported onset of blotchiness on her legs approximately 1 month prior to presentation. She denied any local or constitutional symptoms associated with skin lesions. No history of recent travel or medication changes. Her past medical history is significant for hypothyroidism (controlled on levothyroxine), chronic arthritis, morbid obesity status-post gastric bypass surgery (with subsequent profound weight loss), and anemia secondary to malabsorption. A 10-point review of systems was performed, and did not reveal any new, evolving, or unexplained signs or symptoms.