Yesterday was another busy day at the medical clinic. I'll keep this one short. The cases included asthma, depression, anxiety attacks, bronchitis, urinary tract infection, tonsillitis, and the assortment of colds in the little ones. Sehar came by for his dressing change. His wounds look a little better, and so far, no fevers. The day was mostly typical general medical cases, though incredibly varied. However, there was one jawdropper case.
34 year old woman came in with a couple of skin lesions that are difficult to describe. I believe this is a case when a couple of pictures are worth a thousand words. If you lose your appetite easily, you might think about not clicking the photos for the larger versions.
The interesting thing about this case is that this woman has had these lesions for ten years. She reported that it has not ever gotten better and has only been slowly growing over this time. I can only come up with one potential diagnosis: lepromatous leprosy. Leprosy is one of those diseases that has attained near mythical status from its long documentation throughout human history. I could hardly believe I was potentially seeing a real live case right in front of me. We're going to try her on a course of anti-fungal cream for a week to see if there's any change, but I doubt it's fungal given the history. I'll have to do some more research on this, but if you can think of anything else it might be, let me know.
I did a report in residency on chronic arsenic poisoning, which is a big problem in countires with contaminated water supplies... in Bangladesh, more than 95% of the water supply is potentially arsenic contaminated. The chronic signs include a dermatitis (hyperkeratosis with a "dew drops on a dusty road" appearance) and peripheral neuropathy. I think frequently bottom of feet so maybe less likely here. So interesting what you are seeing!
ReplyDeleteINTERESTING that you mention this actually. I don't think this particular case was arsenic because of the lengthy history and no mental status alterations. BUT, I did get a kid today that got this crusty hyperkeratotic lesion over his right foot that had clear little drops of fluid on the surface of the lesion. I thought to myself, hmm, they look like "dewdrops". Mother said it appeared last week after he had been playing in some water and they didn't recall any trauma to the area. I was thinking fungus, parasite, or some immune reaction. But now I wonder. I need to get more information about arsenic testing in this area because I've been recently reading about how big a problem it is in SE Asia.
ReplyDeleteVery interesting. It looks almost psoriatic in nature, but without the characteristic white/silver scaling. Does it itch or cause her any pain? Does anybody else in her family have it? Was she around anyone with similar lesions? Is it on the soles of her feet too? I'm very curious. Lepromatous leprosy would be quite the brilliant dx. Good luck.
ReplyDeleteShe said there was occasionally slight itching, but otherwise not much and no pain. I think no one else in the family had it, but she only has kids around. Doesn't recall anyone else with the lesions. Not on the soles of her feet. Will be seeing her again this week and will ask more questions. Have to do a pinprick test and see if there's any loss of nerve sensation. There's supposedly another patient that will be coming in next week that has a similar lesion on his leg but even worse looking (I saw a photo). I'll have to try and get a thorough history on him. I agree - really interesting case!
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