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1/
Pathergy - several colleagues mentioned this key concept. Search for a precise definition, we use the term to group skin lesions that worsen w/debridement or even just minor trauma.
#KashlakChief presents #5goodminutes & @thecurbsiders & @CPSolvers @uabimres
Pathergy - several colleagues mentioned this key concept. Search for a precise definition, we use the term to group skin lesions that worsen w/debridement or even just minor trauma.
#KashlakChief presents #5goodminutes & @thecurbsiders & @CPSolvers @uabimres
2/
As the presentation unfolded on Wednesday, the first big clue was that the lesions occurred after seemingly minor scrapes, and then worsened with debridement. The cause of the skin lesions became more complex after we learned that the patient had ESRD on dialysis.
As the presentation unfolded on Wednesday, the first big clue was that the lesions occurred after seemingly minor scrapes, and then worsened with debridement. The cause of the skin lesions became more complex after we learned that the patient had ESRD on dialysis.
3/
The lesions actually looked similar to calciphylaxis. Two findings (prior to biopsy) made that diagnosis less likely. Her Ca 7.5 (alb 2.2) and Phos 4.5 did not give that high a calcium-phosphate product. Then her CT of the lesions did not show calcium.
The lesions actually looked similar to calciphylaxis. Two findings (prior to biopsy) made that diagnosis less likely. Her Ca 7.5 (alb 2.2) and Phos 4.5 did not give that high a calcium-phosphate product. Then her CT of the lesions did not show calcium.
4/
My initial thought was pyoderma gangrenosum. Dermatology had this as one of the two most likely diagnoses also. When you search for pathergy you find a short differential - Behcet's, pyoderman gangrenosum and Sweet's syndrome.
My initial thought was pyoderma gangrenosum. Dermatology had this as one of the two most likely diagnoses also. When you search for pathergy you find a short differential - Behcet's, pyoderman gangrenosum and Sweet's syndrome.
5/
What I learned!! The patient had c/o of fever and malaise. She had elevated ESR and p-ANCA. On biopsy she had microscopic bullae (apparently classic for this diagnosis) & other findings to make the dx. She was on no meds that cause Sweet's & no obvious underlying disease.
What I learned!! The patient had c/o of fever and malaise. She had elevated ESR and p-ANCA. On biopsy she had microscopic bullae (apparently classic for this diagnosis) & other findings to make the dx. She was on no meds that cause Sweet's & no obvious underlying disease.
6/
The good news - she responded quickly to corticosteroids with complete resolution of symptoms and lesions.
The good news - she responded quickly to corticosteroids with complete resolution of symptoms and lesions.
7/
Pro tip!! When you treat a presumed infected ulcer with antibiotics and debridement and it worsens, think pathergy. Call dermatology for a biopsy. Protect the patient from anyone who wants debridement.
Thanks to everyone who commented. I hope you learned something!
Pro tip!! When you treat a presumed infected ulcer with antibiotics and debridement and it worsens, think pathergy. Call dermatology for a biopsy. Protect the patient from anyone who wants debridement.
Thanks to everyone who commented. I hope you learned something!
