2016-2017 Academic Year Archives - Dermatology Grand Rounds

Patient with multiple painful subcutaneous nodules

Chief Editor — Mon, 26 Jun 2017 05:39:31 +0000

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.

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

Chief Editor — Fri, 26 May 2017 05:18:36 +0000

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.

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Multiple painful inflamed nodules, abscesses and draining sinus tracts

Chief Editor — Thu, 25 May 2017 03:24:57 +0000

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.

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

Chief Editor — Sat, 25 Mar 2017 03:14:36 +0000

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.

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A diffuse and morphologically diverse rash in a traveler

Chief Editor — Tue, 17 Jan 2017 03:05:05 +0000

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.

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Diffuse hypopigmented rash on an eight year old girl

Chief Editor — Sun, 01 Jan 2017 03:20:29 +0000

Presenter: Sheena Nguyen, DO

Dermatology Program: Western University of Health Sciences/Chino Valley Medical Center

CHIEF COMPLAINT: White spots all over body

CLINICAL HISTORY: The patient is an eight-year-old girl who presented to the clinic with a three-year history of asymptomatic, hypopigmented macules diffusely spread throughout her body. She denied any preceding illnesses or systemic symptoms. The patient’s mother reported that they had been prescribed and used Triamcinolone 0.1% ointment on the affected areas twice daily for one month, but there was no improvement in her condition. In terms of her medical history, the patient has none of significance. She is currently not taking any medications, and her family history is non-contributory. Socially, she lives at home with her parents, attends elementary school, and denies the use of alcohol, tobacco, or illicit drugs. There has been no recent travel, and she has no surgical history. Additionally, the patient has no known drug allergies (NKDA).

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Lifelong history of brown macules on the lips, buccal mucosa, and hands

Chief Editor — Tue, 27 Dec 2016 07:25:30 +0000

Presenter: Robert Murgia, DO

Dermatology Program: LewisGale Hospital Montgomery

CHIEF COMPLAINT: Brown macules on lips and hands

CLINICAL HISTORY: The patient is a 34-year-old male who presented for a benign skin complaint and upon questioning, reported a lifelong history of brown macules on the lips, buccal mucosa, and hands. At age 13, he presented to his local emergency department with abdominal pain. He was told that this was likely a viral illness, and the pain resolved spontaneously over the next few days. A similar self-resolving episode occurred two years later. At age 16, the pain again returned while the patient was camping, and he was found to have a small bowel obstruction and intussusception. Additionally, he was found to have three large hamartomatous polyps requiring a partial hemicolectomy. He has since had several endoscopies and colonoscopies, as well as numerous gastric and colonic polypectomies. No previous treatments to the lesions. Of note, two brothers (32 and 23), both with similar findings. Father and paternal uncle with similar findings.

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Purpuric rash in a patient with methamphetamine abuse

Chief Editor — Sat, 24 Dec 2016 19:44:16 +0000

Presenter: Doug Richley DO, Emily Kollmann DO, Nicole Tillman DO , Gabriel Guerrero DO

Dermatology Program: Northeast Regional Medical Center

CHIEF COMPLAINT: New purpuric rash on the palmar hands, plantar feet, and perianal region

CLINICAL HISTORY: A 53-year-old female was referred to our office complaining of a new purpuric rash on the palmar hands, plantar feet, and perianal region. The patient reported the rash had been present for six days and she denied any pain or pruritus. She denied any systemic symptoms. No previous treatments. The patient admitted to methamphetamine use the night prior to the onset of the rash. Stating this was her first experience with methamphetamines however she has a known history of drug abuse. She was taking several oral medications daily however none were recently prescribed.

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Generalized erythema and scaling

Chief Editor — Fri, 02 Dec 2016 07:21:53 +0000

Presenter: Alyssa Miceli, DO, Jessica Newburger, DO

Dermatology Program: OMNEE/Park Avenue Dermatology

CHIEF COMPLAINT: Generalized rash

CLINICAL HISTORY: The patient is a 64-year-old Caucasian female with Turner syndrome, CHF, insulin-dependent diabetes mellitus, hypertension, hyperlipidemia, psoriasis and chronic kidney disease was seen as a consultation for a generalized rash that began two days prior to presentation. The patient complained of itching and mild pain of the skin. She was started on fluconazole for a yeast infection and ciprofloxacin for a urinary tract infection five and four days prior to presentation, respectively. The patient had also recently been admitted to the hospital for approximately one month, initially for a CHF exacerbation followed by placement of a gastrostomy tube. New medications during that admission included spironolactone and torsemide. The patient reported a long-standing history of psoriasis for which she has been treated intermittently since childhood. She denied recent exacerbations and was not currently using any topical medications. A review of systems was negative for any acute systemic symptoms.

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Mysterious rash and neurological deficits

Chief Editor — Sun, 27 Nov 2016 07:15:48 +0000

Presenter: Michelle Elway DO, George Brant DO, Jonathan Bielfield DO

Dermatology Program: Colorado Dermatology Institute, RVU

CHIEF COMPLAINT: Diffuse rash

CLINICAL HISTORY: A 44-year-old Burmese female with no significant past medical history presented with fever, pain, swelling, and erythema of her right thumb after a closed injury while working with raw chicken at work. She was diagnosed with a felon and a P1 fracture, subsequently undergoing an I&D. She was then placed on vancomycin, ceftriaxone, and metronidazole for possible exposure to raw chicken to cover empirically for enteric bacteria (salmonella, E. coli, Enterococcus) as well as for skin flora with negative cultures. While being evaluated by ID, they noted multiple dry, erythematous plaques on the face and extremities. They determined “it was likely rheumatologic”, as the patient reported it being present since 2014, and treated by her PCP in Burma. No further workup was performed on that admission. The patient’s thumb improved, and she was discharged home three days later with a 5-day course of Bactrim and amoxicillin.

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