Tuesday, December 02, 2008

That nasty leg ulcer, continued.

OK, people, this is not f***ing "House". I know you were all hoping that this was hyoxanthine-phosphoribosal transferase deficiency associated with self-cannibalism (real disease - look it up) or something of that ilk. This is the real world, folks. Or, i mean, like, the real, like, virtual world, or something.

So, the workup shows:
1. Pan culture negative (mycobacteria and other organisms sometimes take a long time to grow so these are not absolutely excluded).
2. Biopsy: ulceration, granulation tissue etc. Basically non-specific, but no definite organisms like leishmania. 'Special stains' negative. No malignancy was seen (interestingly this was not in the 'crowd's' differential, hmmm.)
3. Tissue immunoflourescence: Unhelpful. Too technical to explain why you should care.
4. Additional travel, social and other history: Unhelpful.
5. Blood test: Monoclonal IgA gammopathy.

Now, who has the answer?


  1. It's a neuropathic ulcer from the peripheral neuropathy commonly associated with paraproteinemias such as IgA gammopathy. It's right over a pressure point (medial malleolus) See Kwan, in Neurologic Clinics - Volume 25, Issue 1 (February 2007) - Copyright © 2007 W. B. Saunders Company.

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  4. good thought but he does not have peripheral neuropathy.

  5. So not Lesch-Nyhan then. Could it be pyoderma gangrenosum?

  6. I'm going with Ellens answer of,over aggressive use of a loufa, while forgetting to utilize the power of lotion.

  7. Eto,
    I don't have an answer, but I do hope your ankle heals quickly! <3

  8. The world's most disgusting tattoo?

  9. Cynic- you rock!!!!!!!

  10. Hey! That was my idea! (not the loofa thing, but the dry skin) :-)

  11. I'm not having fun people! This game sucks for average laymen!

  12. Not a medic, but am having fun trying to pronounce all these diseases. Make sure you include what you do to cure something that yucky. Sure looks painful.

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  14. 3:02 PM, November 10, 2008

    911DOC said...
    of all the presumptuous gall. i knew about you from drackman's blog. i knew you were an idiot from there and all of a sudden you show up on my blog. short fuse? you are part of the problem. telling me that medicine is broken? duh. it's what we've been saying for three years and people like you have broken it by putting personal responsibility behind group politics, gender politics, and common sense. you might not get people speaking their minds to you because you carry the so popular protection of being a woman with you and take advantage of the old school predisposition to not take you too seriously or insult you to your face, well fuck that, the worst thing in the world to happen to our health care system is a bunch of buearucrats and government flunkies taking financial power in the first place. they destroyed the doctor patient relationship and now people like you want to come in and tell me what a problem we have. fuck off....

    AND SHE DID...

  15. It's a freakin' venous insuffiency ulcer or what Scapel said...Dipshits

  16. This IS realistic, a Pathologist takin a Week to make a diagnosis.

  17. CA-MRSA - I Had loads of fun googling "pictures of MRSA" - the infected tattoos were pretty.

  18. OldFart is back! His cuddly charisma is a giveaway :-D

  19. Surgeon Extrordinaire9:37 PM, December 02, 2008

    The diagnosis is irrelevant to the treatment. A chance to cut is a chance to cure.

    Amputate now, diagnose later.

  20. Pyoderma Gangrenosum

  21. The most likely diagnosis is (insert anti-climactic drumroll):


    This is a poorly characterized immune mediated disease that has associations with hematologic disorders (eg IgA gammopathy) and some other immune-type diseases. It causes recurring painful ulcers. Not fun.

    Lessons learned:
    -'The crowd' is stupid.
    -OldFart is BACK!
    -Always listen to S. Cat.
    -Ellen Kimball is annoying.
    -People like pictures of gross shit (aka 'med-porn')

    late, E

  22. Yes! Yes! More med porn, please.

    Farty, big ol' smooches to you!

  23. I was looking at the picture this morning as my kids ate breakfast. Immediately after that, I clicked on a link sent by a friend about fly larva cheese. I thought my poor daughter was not going to be able to finish her breakfast! She told me I have gross friends though.

    Thanks for finally giving the answer!

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  25. Yo bitches!
    Nurse diagnosticians rock!
    (see 09:44, 12/02/08.
    I even put the date in the wrong way round to help my trans-atlantic brethren!

  26. now it's on my damn ankle

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  28. Yo cat - you the man! Sorry didn't pick up on our previous answer in the other thread. Hats off to the big pussy!

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  30. That's not my ego. Stroke it to the left, stroke it to the right....

  31. You know that cute move kitties do with their hind legs? Its a dis-emboweling technique.....

  32. Space monkeys ate his ankle.


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  34. This exercise stands as a continual reminder that as a layperson, I really don't know anything about medicine. I don't know how ya'll retain the sheer volume of factoids and stuff.

    But strangely, you don't seem shy about demonstrating this fact. Repeatedly. Daily. Painfully.

  35. I have no problem with the fact that I'm not the best or the brightest. I come here to laugh and because I learn things.

    At least I'm not an anonymous coward, asshole.

  36. Tell 'em Amy. :o)

    I love this blog. You guys crack me up.

  37. Etothepi,
    Are you really a Dr? Are you a retarded Doc? Do you understand basic statistical and /or sampling techniques?
    1)You asked the masses a question but withheld info.
    2) They got it wrong
    3) You gave more info
    4) They got it right
    5) You call THEM dumb
    6) Well I am Them calling YOU dumb
    5)Six was meant to be a bit be a stupid comment so that you could save face by discrediting your detractor (me) and therby distracting others from the validity of the accusation.
    8) #7 was intentionally labled "5"
    9) Are you aware that most respondants said Pollyanna Gang Green-osa (or whatever it was) before your great "reveal"?
    10) Are you single?

  38. Anon:

    Chicks dig me cause I rarely wear underwear.

    I think I have proven my point.

  39. Precisely my point is that you THINK you have proven your point, but give NO supporting evidenciary support nor any athletic support (based on your underwear comment).

    Awl playing aside (Awls are dangerous and should not be played with)

    Did not the wisdom of the masses match that of the expert?

    Sharon Scheralyke

  40. Punny Anon:

    The question was: will a sampling of diagnostic considerations from experts and non-experts come up with the right dx as a majority opinion in this case? The answer to this question is a resounding "NO".

    We can ergo conclude that:
    1. "The crowds" are not wise (aka stupid).
    2. I am a genius and infrequently wear undergarments.
    3. You and Ellen Kimball should get together and have a circle jerk / daisy chain.
    4. Don't fuck with Mr. Zero (citation please)
    5. Don't fuck with the Jews (citation please)
    6. Don't fuck with me. (citation not needed)

    Sincerely, Dana Mont


  41. Also, don't fuck with the pancreas.