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Sthanu

Feb 11 • 6 tweets • 2 min read

A 50-year-old man

👉1-year history of itchy axillary and groin lesions

👉treated with a topical antifungal preparation (cyclopyroxolamin), without improvement

Diagnosis?

👉well-circumscribed, erythematous, brownish, scaly plaques affecting both armpits and the groin area bilaterally

👉skin scrapings did not isolate any dermatophytes in Sabouraud agar.

Gram staining confirmed erythrasma
♦️
Corynebacterium minutissimum was isolated in culture
♦️
topical application of erythromycin gel twice a day, and the skin lesions resolved in 2 weeks.

Erythrasma is a superficial infection caused by Corynebacterium minutissimum

Absence of satellite papulopustules is suggestive of erythrasma.

Gram stain and culture can be used together to differentiate fungal and Corynebacterium minutissimum infection

Axillary and inguinal erythrasma

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Feb 13

What is Buttonhole sign?

Buttonhole sign

In type 1 neurofibromatosis (Von-Recklinghausen's disease)

👉neurofibromas can be invaginated with the tip of index finger back into the subcutis and again reappear after release of pressure.

Buttonhole sign

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Sthanu

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Feb 13

What’s the likely diagnosis?

(A) Norwegian scabies

(B) Tripe palms, acanthosis nigricans

(C) Hyperkeratotic eczema

(D) Tinea manuum

A 73-year-old woman

👉 smoking history of 30 pack-years

👉 pruritic and painful lesions on the palms of her hands that had first appeared 9 months earlier

👉 reported a cough that had been present for 1 year

👉 weight loss of 5 kg over the past 4 months

👉 examination revealed sharp demarcation of the folds in the lines of her hands

👉 a velvety appearance of palmar surfaces and ridging of the skin (Panel A).

Read 8 tweets

Sthanu

@Sthanu5

Feb 12

Long standing abdominal bloating and malabsorption

Diagnosis? Sign?

Scleroderma - small bowel involvement

This patient had known long standing scleroderma and demonstrates characteristic small bowel follow-though appearances.

Hide-bound sign

👉 is seen on barium studies of the small bowel in patients with scleroderma.

👉 sign describes a narrow separation between valvulae conniventes of normal thickness despite dilatation of the bowel lumen

Read 6 tweets

Sthanu

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Feb 12

About 50% of patients with deep vein thrombosis (DVT) also have which of the following conditions?

A.
Occult cancer

B.
Occult pulmonary emboli

C.
Protein C deficiency

D.
Sickle cell anemia

Answer

B.
Occult pulmonary emboli

About 50% of patients with DVT have occult pulmonary emboli

👉 at least 30% of patients with PE have demonstrable DVT

Read 8 tweets

Sthanu

@Sthanu5

Feb 12

These oral ulcers were painless. What is the most likely diagnosis?

Chancroid

Herpes simplex

Iron deficiency

Squamous cell cancer

Syphilis

A 25-year-old man with no major medical conditions

👉 2-month history of two painless ulcerated lesions in the midline of the lower and upper lips

👉 round ulcers measured 0.8 cm to 2.4 cm in diameter with clean, smooth bases and slightly elevated, indurated borders

👉 also reported a 1-week history of symmetrically distributed nonpruritic macules on his trunk and limbs.

Read 8 tweets

Sthanu

@Sthanu5

Feb 11

What's the most likely diagnosis?

53 year-old with mild shortness of breath

Hiatal hernia

Pneumothorax

Pneumonia

Pulmonary infarct

Left lower lobe atelectasis

Single axial CT scan of the chest on a different patient with same disease

Answer:

5. Left lower lobe atelectasis

Read 8 tweets

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