2016-2017 Academic Year Archives - Dermatology Grand Rounds

Patient with multiple painful subcutaneous nodules

June 26, 2017

Presenter: Rachel Cetta DO, Sonam Rama DO

Dermatology Program: SCS/MSUCOM/Beaumont Hospital-Trenton

CHIEF COMPLAINT: Painful nodules located on her back and arms

CLINICAL HISTORY: A 55-year-old female with bipolar disorder, osteoarthritis, pulmonary embolism, deep vein thrombosis, breast cancer, and depression was referred to our office complaining of painful nodules located on her back and arms. The patient reported the lesions on her upper extremities and trunk had been present for forty plus years and had endured twenty-four excisions to remove these nodules. Patient stated the nodules were tender to palpation and would get severe sharp shooting pain in these lesions. Patient had tried gabapentin but it caused her to have dizziness, and patient was currently being treated with pregabalin (50 mg BID) for alleviation of pain. This did control the pain at times, but did not take it away completely.

Recurrent erythematous papules and nodules on the back of right lower leg

May 26, 2017

Presenter: Richard Winkelmann, DO; Jessica Hoy, DO; Kylee Sacksteder, DO; Gabriella Maloney, DO; Alyson Ridpath, DO

Dermatology Program: OhioHealth Dermatology Columbus, OH

CHIEF COMPLAINT: Recurrent bumps on back of right lower leg

CLINICAL HISTORY: A 64-year-old immunocompetent female presented with a seven-month history of recurrent erythematous papules and nodules on the back of her right lower leg. She reported that the nodules were tender, nonpruritic, and, at times, had a clear exudate. The patient denied any trauma to the area and initially attributed the eruption to mosquito bites. No previous treatments. Patient denied any personal or family history of skin cancers, and her medical history was unremarkable without prior exposure to tuberculosis or recent travel out of the country.

Multiple painful inflamed nodules, abscesses and draining sinus tracts

May 25, 2017

Presenter: Michael Lipp, D.O. Nady Hin, D.O., Rachel White, D.O.

Dermatology Program: LECOMT/Larkin Community Hospital Palm Springs Campus

CHIEF COMPLAINT: Inflammatory nodules/abscesses and joint pain

CLINICAL HISTORY: Twenty-year-old male presents with history of multiple painful inflamed nodules, abscesses and draining sinus tracts involving the face, chest, axilla, groin, and back for which was diagnosed as Hidradenitis Suppurativa (HS). Patient reports surgical history of multiple sinus tract excisions. Past medical history includes scarring acne of the face, chest, and back, pilonidal cyst that was surgically removed, and Crohn’s disease. Upon further questioning, it was learned that the patient was worked up at the hospital for back pain years prior. During that hospital stay an MRI revealed sacroiliitis and patient has been subsequently following up with a Rheumatologist.

One year history of an erythematous, mildly pruritic rash on the chest and breasts

March 25, 2017

Presenter: Roxanne Rajaii DO, Derek Hirschman DO, Summer Moon DO, Megan Furniss DO, Nichelle Arnold DO, Bryan Gray DO

Dermatology Program: Botsford Hospital

CHIEF COMPLAINT: Erythematous and mildly pruritic rash on central chest and bilateral breasts.

CLINICAL HISTORY: A 29-year-old Caucasian female presented with chief complaint of an erythematous and mildly pruritic rash localized to bilateral breasts and present for approximately one year. The patient denied any recent infections, new medications, or exacerbating factors. She denied any other constitutional symptoms including but not limited to fever, chills, and night sweats. She did admit to a long-standing history of smoking but stated that she is in the process of cessation. Patient reported exacerbation of skin lesions with sun exposure. Patient had been previously treated with topical combination hydrocortisone and lotramine, as well as topical clotrimazole/betamethasone diproprionate ointments with no improvement.

A diffuse and morphologically diverse rash in a traveler

January 17, 2017

Presenter: Leslie Marshall, D.O.

Dermatology Program: Northeast Regional Medical Center

CHIEF COMPLAINT: “itchy rash”

CLINICAL HISTORY: A previously healthy, non-pregnant 22-year-old Hispanic female presented with a 5-day history of a pruritic eruption on her dorsal right hand, upper arms, and back. She had returned to the United States 4 days prior after a 2-week trip to Santa Anna, El Salvador. Her symptoms began one week after her arrival to El Salvador with neck swelling and general malaise. One day before returning home (day 7 of illness), she developed tenderness and swelling surrounding a mosquito bite on her right ankle followed by a rash on her arms, back, and thighs. Accompanying symptoms included arthralgias in her hands, a low-grade fever, headache, and paresthesias. She was prescribed a prednisone taper from the ER physician, which was not helpful. She reported being bitten several times by mosquitos while in El Salvador.