2016-2017 Academic Year Archives - Page 2 of 4

Diffuse hypopigmented rash on an eight year old girl

January 1, 2017

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).

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

December 27, 2016

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.

Purpuric rash in a patient with methamphetamine abuse

December 24, 2016

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.

Generalized erythema and scaling

December 2, 2016

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.

Mysterious rash and neurological deficits

November 27, 2016

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.