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?

45 comments:

  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.

    ReplyDelete
  2. This comment has been removed by the author.

    ReplyDelete
  3. This comment has been removed by the author.

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

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

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

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

    ReplyDelete
  8. The world's most disgusting tattoo?

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

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

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

    ReplyDelete
  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.

    ReplyDelete
  13. This comment has been removed by the author.

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

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

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

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

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

    Amputate now, diagnose later.

    ReplyDelete
  19. Pyoderma Gangrenosum

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

    PYODERMA 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

    ReplyDelete
  21. Yes! Yes! More med porn, please.

    Farty, big ol' smooches to you!

    ReplyDelete
  22. 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!

    ReplyDelete
  23. This comment has been removed by the author.

    ReplyDelete
  24. now it's on my damn ankle

    ReplyDelete
  25. This comment has been removed by the author.

    ReplyDelete
  26. This comment has been removed by the author.

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

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

    ReplyDelete
  29. Space monkeys ate his ankle.

    Duh.

    ReplyDelete
  30. This comment has been removed by the author.

    ReplyDelete
  31. 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.

    ReplyDelete
  32. Tell 'em Amy. :o)

    I love this blog. You guys crack me up.

    ReplyDelete
  33. 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?

    ReplyDelete
  34. Anon:

    Chicks dig me cause I rarely wear underwear.

    I think I have proven my point.

    ReplyDelete
  35. 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

    ReplyDelete
  36. 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

    Out

    ReplyDelete

ALL SPAM AND GRATUITOUS LINK POSTINGS WILL BE IMMEDIATELY DELETED.