Sunday, August 13, 2006

Peruvian farmer with multiple skin ulcers



An 18 yr old male Peruvian farmer presents to the clinic with multiple lesions on his arms and legs. He denies any water exposure and states that a single lesion erupted on his right arm 3 months ago. Since its onset, multiple other lesions have erupted throughout his right arm and legs as well. He denies any pruritis, or any secretions from the ulcerated lesions. He also has attempted some home remedies including herbals without any relief.
On physical exam, he is afebrile and his vital signs are stable. Skin exam reveals multiple ulcerations and crusts on the posterior side of his right arm, of different sizes. These lesions have well defined borders, with an erythematous base, and no secretions.

What is the most appropriate treatment of this condition?
1. Clarithromycin 500mg twice daily
2. Pentavalent Antimony for 20 days- ANSWER
3. Penicillin G - 2 million units q3hrs IV for 7 days
4. Itraconazole 200mg daily for 3-6 months.

Sunday, August 06, 2006

Swelling on the foot


56 y, white gentleman, working as a mechanic for the MTA, comes in for slowly progressive asymptomatic swelling on the dorsum of his Right foot, over the past few years. He does not recollect any trauma.
Exam shows a 4-5 cm, non- inflamed, firm swelling, with very limited mobility and with definite transillumination, on the dorsum of the foot along the lateral aspect.

What is the most likely diagnosis based on the available information?

1. Bible cyst- ANSWER.
2. Lipoma
3. Neuroma
4. Epidermoid cyst
5. Surfer’s nodules