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Two Brown Spots on the Left Hand

Presenter: Sun Coast Hospital, Matthew Muellenhoff , DO (2nd year resident), Thi Tran, DO (2nd year resident), Frank Armstrong , DO (3rd year resident), Kathleen Soe, DO (3rd year resident), Greg Houck, DO (1st year resident), Marya Cassandra, DO (1st year resident)
Dermatology Program: Sun Coast Hospital, NOVA Southeastern University Dermatology Program
Program Director: Richard Miller, D.O.
Submitted on: Nov 29, 2002

CHIEF COMPLAINT:  Two Brown Spots on the Left Hand

CLINICAL HISTORY:

Signs and symptoms:  The patient reported a 5-year history of two brown spots on the left hand. Initially the lesions were blue and attributed to ink stains although the patient denied contact with any staining chemicals or dyes. The “spots” increased in size over a two-year period and changed from blue to brown in color. She denied recent travel and had no history of skin cancer or atypical nevi. Family history revealed a brother with a history of melanoma. Her medications included premarin and glucosamine and she denied any allergies.

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Blistering skin disease since birth

Presenter: Michael Sabat, MS, DO (2nd year resident), Megan Goff, DO (1st year resident), and Sam Smith, MPH, DO (1st year resident)
Dermatology Program: Stephen Kessler, D.O.
Program Director: Stephen Kessler, D.O.
Submitted on: Oct 29, 2002

CHIEF COMPLAINT:  Painful blisters/ ulcerations since birth

CLINICAL HISTORY:

Signs and symptoms:  Fragility of skin and slow healing, scarring erosions and ulcers, difficulty swallowing, decreased appetite and weight loss

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Pruritic Painful Groin Rash

Presenter: Laurie Schaeffer, D.O. (Third Year Resident), Michael Eyre, D.O. (Third Year Resident), Wendy McFalda, D.O. (Second Year Resident), Cindy Lavery, D.O. (First Year Resident)
Dermatology Program: Pontiac Osteopathic Hospital
Program Director: Sandy Goldman, D.O.
Submitted on: Sep 29, 2002

CHIEF COMPLAINT:  Pruritic, painful groin rash for approximately six weeks

CLINICAL HISTORY:

Signs and symptoms:  The patient experienced a painful, pruritic, and progressive rash located in the groin. The rash began on the sides of his scrotum and had steadily progressed to involve the entire scrotum, sides of the penis, and upper thighs. He had difficulty ambulating and washing the area due to the intense pain. He denied any dysuria, hematuria, or discharge. He could not recall similar outbreaks and denied any constitutional symptoms. He complained of occasional diarrhea.

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Subcutaneous Nodules on the Face, Neck, and Upper Extremities

Presenter: Robert J. Zabel, DO (Resident)
Dermatology Program: Philadelphia College of Osteopathic Medicine / Lehigh Valley Hospital
Program Director: Stephen Purcell, DO
Submitted on: Aug 29, 2002

CHIEF COMPLAINT:  Chest pain and shortness of breath

CLINICAL HISTORY:

Signs and symptoms:  A 60-year-old Hispanic female with a two-year history of idiopathic crescentic glomerulonephritis presented with chest pain and shortness of breath. Cardiac ischemia was excluded from serial lab studies and intravenous heparin was started for a potential pulmonary embolism. On hospital day three, subcutaneous nodules were noted on her forehead. These nodules rapidly increased in size and number over a 24-48 hour period. They spread rapidly over the face, neck, upper trunk, and upper extremities. The subcutaneous nodules transitioned to exophytic and weeping lesions. On hospital day seven, she developed a productive cough with blood-tinged sputum and a chest radiograph showed diffuse bilateral infiltrates. A pulmonary angiogram was negative for an embolism and anticoagulation was stopped. A bronchoscopy revealed nodules lining the bronchi and diffuse alveolar hemorrhage.

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Translucent and Hyperpigmented Papules and Nodules on the Upper Back and Neck

Presenter: Stephen Mallette DO, Alpesh Desai DO
Dermatology Program: Western University College of Osteopathic Medicine of the Pacific
Program Director: David C. Horowitz DO, Mark K. Horowitz DO
Submitted on: Jul 29, 2002

CHIEF COMPLAINT:  Painless papules on the upper back for three months, which are increasing in size and number.

CLINICAL HISTORY:

Signs and symptoms:  The patient states that lesions are non-tender and have enlarged slowly over time. The patient also states that new lesions also occur over time. There is no pruritus or discharge from the lesions. They occur only on the upper back and neck.

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