Today's Medical Mysterie
-
https://www.nejm.org/doi/full/10.1056/NEJMicm2313828?query=WB
A 59-year-old veterinarian presented to the dermatology clinic with a 1-year history of a painful rash on his right hand. He had no other symptoms. On physical examination, verrucous plaques with overlying thick yellow-brown crusting were seen on the dorsum of the right hand (Panel A) and the medial aspect of the right index finger (Panel B).
***Gross Medical Picture***
click to showA diagnosis of tuberculosis verrucosa cutis was made. Tuberculosis verrucosa cutis is a type of cutaneous tuberculosis that results from direct inoculation of the organism into the skin of previously sensitized persons. Occupational exposure to mycobacteria, particularly among persons with frequent contact with livestock, is a risk factor. A 6-month course of isoniazid, rifampin, and ethambutol was initiated. At 2 months of follow-up after the start of antituberculous therapy, the rash had abated.
Wait, he had this rash FOR A YEAR before seeking treatment?
-
A few weeks ago I got a call from a woman, told me there was something on her husbands shoulder that she didn’t think looked right. Could she bring him in to my office and have a look? I said sure.
Couple walks in. Look normative. He takes off his shirt to show me his shoulder
Was there for about 6-8 months. He thought it would go away.
(Bad bad melanoma. Big lymph nodes in axilla)
-
A few weeks ago I got a call from a woman, told me there was something on her husbands shoulder that she didn’t think looked right. Could she bring him in to my office and have a look? I said sure.
Couple walks in. Look normative. He takes off his shirt to show me his shoulder
Was there for about 6-8 months. He thought it would go away.
(Bad bad melanoma. Big lymph nodes in axilla)
-
@bachophile what's his prognosis?
What therapy?
@George-K immunotherapy
five yr survival 50-60% if he is lucky.
Ten years ago would have been dismal but immunotherapy has made a big improvement in survival
