Derm Dx

Monday, April 25, 2016
A 58-year-old African American woman presented to the emergency department with a 1-week history of tender sores and erosions on her arms, legs, and trunk.
Friday, June 7, 2013
A 49-year-old white female presented with the chief complaint of a small swelling lesion over her right index finger close to her nail. The lesion was present for 2 years and was mildly painful and occasionally accompanied by drainage of a white-yellowish material.
Tuesday, June 5, 2012
Patient Presentation: A 17-year-old boy presented with mildly pruritic, violaceous papules and plaques on the left side of his chest that had slowly extended over the past 6 months. He reported no pain and no history of applying topical substances. There was no history of a similar rash. He had chicken pox several years before, but his history was otherwise unremarkable. On examination, the rash, at first look, had a dermatomal distribution and consisted of violaceous plaques (see Figure 1). Hair, nails and mucus membrane examinations were normal. WHAT IS YOUR DIAGNOSIS?
Thursday, May 3, 2012
Patient Presentation A 46-year-old female presented with painful blisters on her dorsal hands. She reported two previous similar episodes but denied other medical problems aside from perimenopausal symptoms treated with estrogen hormone therapy. On physical examination, the patient had erythematous, flaccid bullae localized to the dorsal hands, bilaterally (see Figure 1). She also had fine hypertrichosis of her temples and preauricular cheeks. She had subtle sclerodermoid changes including perioral rhytids and she appeared older than age stated (see Figures 2 and 3). Two 4-millimeter punch biopsies were obtained and submitted for hematoxylin and eosin stain (H&E) and direct immunofluorescence (DIF) in addition to bacterial and viral cultures. WHAT IS YOUR DIAGNOSIS?
Monday, April 9, 2012
PATIENT PRESENTATION A 43-year-old man presented for a routine skin check with a several year history of unilateral, yellowish, pearly papules on the left lower eyelid. The lesions were completely asymptomatic and did not affect his vision. The patient had no allergies, was not taking any medications and had an otherwise unremarkable medical history, only describing a shoulder injury as a teenager. Furthermore, he reported no family history of similar skin findings or autoimmune disease. A punch biopsy was obtained for histological examination. WHAT IS YOUR DIAGNOSIS?
Tuesday, March 6, 2012
Patient Presentation A 63-year-old man presented for evaluation of newly appearing, diffusely distributed, pruritic skin lesions. The patient’s medical history was significant for essential thrombocytosis initially diagnosed in 2007 that was unresponsive to several treatments, including hydroxyurea and anagrelide. He was admitted to the hospital, where he was seen in consultation for evaluation of recently developed anemia and thrombocytopenia; a bone marrow biopsy also showed 80% blasts. Induction chemotherapy with bendamustine per study protocol was initiated for newly diagnosed acute myelogenous leukemia. Physical examination revealed erythematous papules, nodules and plaques on the scalp, face, chest, back and upper extremities (Figures 1 and 2). Examination of the oral cavity demonstrated a 1-cm ulcer on the buccal mucosa and a small stellate fissure on the distal tip of the tongue. Punch biopsies of representative skin lesions on the right chest and left cheek were obtained. WHAT IS YOUR DIAGNOSIS?
Friday, February 3, 2012
Patient Presentation A 55-year-old Caucasian male presented to the emergency department with a 2-day history of what looked like dried crusts of blood on his forearms. They were mildly painful and tender, but non-pruritic. His medical history was significant for atrial fibrillation, treated with sotalol and direct current cardioversion 2 weeks prior. At that time, enoxaparin was started to bridge anticoagulation to warfarin. Concurrent medications included aspirin. Physical examination revealed scattered, discrete and coalescent, 3-mm to 5-mm, tense, superficial hemorrhagic vesicles on an erythematous base located on the bilateral forearms (see image above). Abdominal skin examination revealed large ecchymoses located at injection sites. Laboratory results showed normal platelets, hemoglobin and hematocrit values. The international normalized ratio and partial thromboplastin time were slightly increased (1.27 (normal 0.9 to 1.1 seconds) and 36.8 seconds (normal 23.0 to 34.0 seconds), respectively). Biopsy was obtained and evaluated for definitive diagnosis.
Thursday, January 12, 2012
PATIENT PRESENTATION A previously healthy 64-year-old Caucasian male presented to the outpatient dermatology clinic with a progressive red, pruritic rash on his abdomen and back. On physical examination, there was an extensive erythematous eruption with a scaly sharply demarcated serpiginous border on his abdomen and neck. What is your diagnosis?
Tuesday, December 6, 2011
Patient Presentation A 63-year-old female presented with an erythematous rash on her right upper arm and forearm. The lesion began at the age of 18 years and initially involved only her right forearm. Over several years, the lesion extended proximally to also involve the right upper arm. The lesion was asymptomatic and blanched with pressure. What is your diagnosis?