AOCD Grand Rounds is founded by Dr. Bill Way and Dr. Rick Lin under the leadership of AOCD President Cindy Hoffman DO FAOCD in 2002. Over the past 14 years, the Residency Programs of the American Osteopathic College of Dermatology have been submitting interesting cases for publication. We welcome your comments and submissions.
Presenter: Robert Murgia, DO
Dermatology Program: LewisGale Hospital Montgomery
Program Director: Daniel Hurd, DO
Submitted on: Dec 4, 2016
CHIEF COMPLAINT: Brown macules on lips and hands
Signs and symptoms: 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.
Presenter: Doug Richley DO, Emily Kollmann DO, Nicole Tillman DO , Gabriel Guerrero DO
Dermatology Program: Northeast Regional Medical Center
Program Director: David Cleaver DO FAOCD
Submitted on: Feb 4, 2016
CHIEF COMPLAINT: A 53-year-old female was referred to our office complaining of a new purpuric rash on the palmar hands, plantar feet and personally.
Presenter: Alyssa Miceli, DO, Jessica Newburger, DO
Dermatology Program: OMNEE/Park Avenue Dermatology
Program Director: Karthik Krishnamurthy, DO, FAOCD
Submitted on: Dec 2, 2016
CHIEF COMPLAINT: Generalized rash
Signs and symptoms: Patient is a 64-year-old Caucasian female 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. Review of systems was negative for any acute systemic symptoms.
Past Medical History: Turner syndrome, CHF, insulin-dependent diabetes mellitus, hypertension, hyperlipidemia, psoriasis and chronic kidney disease Continue reading “Generalized erythema and scaling”
Presenter: Michelle Elway DO, George Brant DO, Jonathan Bielfield DO
Dermatology Program: Colorado Dermatology Institute, RVU
Program Director: Reagan Anderson DO
Submitted on: Nov 29, 2016
CHIEF COMPLAINT: Diffuse rash.
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 work-up 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. Continue reading “Mysterious rash and neurological deficits”