Thread by @JonathanDauMD

Derm/Rheum Consult 1: 82yoW w/ HTN, breast can, new annular rash. Skin bx eosinophilic lymphocytic infiltrate. Gave 1mg/kg steroids.
ANA+ with centromere pattern, CREST?
==>#UnmaskSx with Steroids when tapering steroids.
==>Deep perivascular infiltrate on bx = Derm IDK!

1/

Derm/Rheum Case 2: 78yoF MGUS,HFpEF, rash on legs. ?purpura. w/u Cryocrit normal , RF+ skin bx C3 in vessel walls, LCV.
Dx: Type II Cryo
Learning Pearl: Retiform purpura "angular stellate rash" pic below and diagram -> VASCULITIS or VASCULOPATHY

#dermtwitter #rheumatology
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Derm/Rheum 3: Bullous Rash? DDx: Bullous Lupus vs. Epidermal Bullous Acquisita (EBA) vs. Bullous Pemphigoid
Learning Pearl:
Minimal trauma w/ blisters = EBA, treat with dapsone +/- prednisone
Consult Derm!

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Derm/Rheum 4: PT with chronic lyme with fevers and new rash. (ddx table below)
BUT: had a linear forehead scar => Linear Morphea?
Linear Morphea can have brain atrophy.

Derm/Rheum Case 5: Pt with rash, Pain Persistence and Pigmentation (3P's) = Urticarial Vasculitis. Pt started on dapsone.
BUT-> Came back with green rash
Hemolytic anemia with dapsone!
Green = Yellow (Jaundice) and Blue (Cyanosis)

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Derm/Rheum Case 6: Man with a case of sarcoid.
Nodules found on tattoo. SkinBx showed granulomatous sarcoid.

Learning Pearl: Skin Sarcoid can regress later than systemic sarcoid and may require topical steroids.

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Thanks so much @DrStevenTChen!
Interesting cases that help Dermatologists and Rheumatologists work together and collaborate on our interesting cases.

#MedEd #DermTwitter #MedThread #RheumTwitter #AdvancesinRheum2019