SDPA Summer | Live Blog | Challenging Cases in Medical Dermatology
On the third day of the SDPA’s Annual Summer Conference, Drs. Ted Rosen, Dr. Alain Rook, Dr. Amit Pandya and Kirk Gautier, PA-C presented challenging medical cases in dermatology. Dr. Rosen initiated the discussion with his presentation of the “elusive granuloma”. He described a case of a rapidly growing facial nodule that evaded diagnosis despite cultures and biopsy. With further investigation and several biopsies, a diagnosis of post-transplant lymphoproliferative disorder was made. This condition presents in transplant patients, most often lung and heart transplant patients. The diagnosis is prudent because it worsens the five-year survival of these transplant patients and treatment is reducing the patient’s immunosuppression.
Next, Dr. Alain Rook reviewed the erythrodermic presentation of cutaneous T-cell lymphoma (CTCL) and the key components of diagnosis. If a patient presents with erythroderma and ectropion, a diagnosis of erythroderma CTCL should be considered. Proper diagnosis of CTCL requires an adequate physical exam including palpation of the lymph nodes, obtaining more than one biopsy, and flow cytometry. Fortunately, CTCL is highly responsive to treatment with immune potentiators.
Do you know the most common initial site of presentation of vitiligo in adults and children? Dr. Amit Pandya described involvement of the hands as the most common initial presentation of vitiligo in adults and the face in children. He presented an interesting case of a Hispanic female patient who presented with greater than a 50% surface area of vitiligo who recently started having active disease in her face. This patient’s rural residence made it difficult for this patient to travel for in office phototherapy. For these patients, home phototherapy is an option that should be considered.
Lastly, Kirk Gautier, PA-C, presented the unique case of a young female who presented with a painful, itchy progressive rash that eluded diagnosis for weeks by several providers. The final diagnosi , thanks to the guidance of a primary care physician assistant who had previous exposure to this condition, was disseminated gonococcal infection. This can present in up to 3% of patients with gonorrhea. This presentation is most common in women under the age of 40 years.
Byline: Sarah Patton, PA-C, MSHS
Posted: June 3, 2017