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

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

CLINICAL HISTORY:

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.

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Purpuric rash in a patient with methamphetamine abuse

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.

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Generalized erythema and scaling

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

CLINICAL HISTORY:

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
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Mysterious rash and neurological deficits

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”

58yo female with hyperpigmented papules on arms and palms

Presenter: Olga Demidova, DO; Laura Jordan, DO; Cole Cahill, DO; Schield Wikas, DO; Monte Fox, DO
Dermatology Program: Tri-County Dermatology
Program Director: Schield Wikas, DO
Submitted on: Nov 5, 2016

CHIEF COMPLAINT:  A 58-year-old female presented to the dermatology clinic with complaints of asymptomatic hyperpigmented papules over arms and palms.

CLINICAL HISTORY:

Signs and symptoms:  A 58-year-old female was referred to the dermatology clinic by her primary care physician for evaluation of asymptomatic hyperpigmented papules involving her arms and palms. Growths appeared several weeks prior to the initial visit. During the visit, the patient reported mild shortness of breath that is chronic for her and may have worsened in the past few weeks. She denied changes in medications and any recent illness.

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