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?
Tuesday, December 02, 2008
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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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ReplyDeletegood thought but he does not have peripheral neuropathy.
ReplyDeleteSo not Lesch-Nyhan then. Could it be pyoderma gangrenosum?
ReplyDeleteHerpes...
ReplyDeletepyoderma gangrenosum
ReplyDeleteCa. ?
ReplyDeleteI'm going with Ellens answer of,over aggressive use of a loufa, while forgetting to utilize the power of lotion.
ReplyDeleteEto,
ReplyDeleteI don't have an answer, but I do hope your ankle heals quickly! <3
The world's most disgusting tattoo?
ReplyDeleteCynic- you rock!!!!!!!
ReplyDeleteHey! That was my idea! (not the loofa thing, but the dry skin) :-)
ReplyDeleteMultiple Myeloma
ReplyDeleteI'm not having fun people! This game sucks for average laymen!
ReplyDeleteIschemic Ulcer?
ReplyDeleteNot 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.
ReplyDeleteThis comment has been removed by the author.
ReplyDeleteIt's a freakin' venous insuffiency ulcer or what Scapel said...Dipshits
ReplyDeleteThis IS realistic, a Pathologist takin a Week to make a diagnosis.
ReplyDeletePressure ulcer.
ReplyDeleteCA-MRSA - I Had loads of fun googling "pictures of MRSA" - the infected tattoos were pretty.
ReplyDeleteOldFart is back! His cuddly charisma is a giveaway :-D
ReplyDeleteThe diagnosis is irrelevant to the treatment. A chance to cut is a chance to cure.
ReplyDeleteAmputate now, diagnose later.
Pyoderma Gangrenosum
ReplyDeleteSweet's syndrom
ReplyDeletepemphigus?????
ReplyDeleteThe most likely diagnosis is (insert anti-climactic drumroll):
ReplyDeletePYODERMA GANGRENOSUM
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
Yes! Yes! More med porn, please.
ReplyDeleteFarty, big ol' smooches to you!
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.
ReplyDeleteThanks for finally giving the answer!
This comment has been removed by the author.
ReplyDeletenow it's on my damn ankle
ReplyDeleteThis comment has been removed by the author.
ReplyDeleteI got it first, bi-atches.
ReplyDeleteCAT
This comment has been removed by the author.
ReplyDeleteThat's not my ego. Stroke it to the left, stroke it to the right....
ReplyDeleteYou know that cute move kitties do with their hind legs? Its a dis-emboweling technique.....
ReplyDeleteSpace monkeys ate his ankle.
ReplyDeleteDuh.
This comment has been removed by the author.
ReplyDeleteThis 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.
ReplyDeleteBut strangely, you don't seem shy about demonstrating this fact. Repeatedly. Daily. Painfully.
Tell 'em Amy. :o)
ReplyDeleteI love this blog. You guys crack me up.
Etothepi,
ReplyDeleteAre 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?
Anon:
ReplyDeleteChicks dig me cause I rarely wear underwear.
I think I have proven my point.
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).
ReplyDeleteAwl 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
Punny Anon:
ReplyDeleteThe 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
Out