Monday, September 19, 2011

A Case for Discussion


Notice obvious nodules. distal to nodules you can make out, in this poor film, some lesions that almost look like comedones. All questions answered promptly. Fire away!

30 comments:

  1. sporotrichosis, bitch

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  2. if thats not a textbook case of Blue Rubber Bleb Nevus Syndrome(BRBNS), then I'm a Hindu...
    Ofcourse I could be wrong, let me know what the CD202B is...
    Oh sorry, "TEK Tyrosine Kinase" for those not up on there molecular biochemistry.
    I know its a "Zebra" and "Common Things are Common" and "You can't diagnose what you don't know"
    in fact, I wouldn't know about it if I didn't see it on "House MD"...

    Frank

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  3. No, no, and he'll no! These lesions developed after a "close personal interaction" with a stranger.

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  4. is this an arm or a leg?

    ms1

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  5. It's a huge penis... Okay, it's an arm.

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  6. what was his chief complaint? are these nodules painful?

    ms1

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  7. Symptoms? How intimate was the contact?

    M

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  8. initial complaint was pain and bleeding. All resolved. Stable for 5 years without change. Contact was from about twenty feet away.

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  9. Come on now, what was the contact?
    so, asymptomatic now?
    similar lesions elsewhere?
    I am assuming pain and bleeding was localized to that site only?

    M

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  10. im starting to think that the relevant info in the original presentation was "fire away"

    ms1

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  11. Trauma? medications/drugs? IVDA? Where was the pt 5 yrs ago? age?

    M

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  12. That Arm, its so....
    Vein-ey....

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  13. he was in Iraq at the time, and there WAS trauma. on the other arm he has a tattoo which is, if I'm not mistaken, a unit insignia from one of our more elite military units. but I like the botfly and spirochete answer.

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  14. The pigmentation could have been tattooing from the trauma wound ( bullets/dirt/grease/blood.) The trauma could have led to inoculation of dermal/environmental organisms or from handling of the wound, which is the cause of those nodules. How are the sensations in that area? Any other lesions?
    How long did the bleeding and pain last?
    I am guessing leprosy/syphillis/leshmaniasis.
    M

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  15. So the contact was a bullet(stranger) wound from 20 feet away?

    M

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  16. M,
    almost completely correct, but there is no reactivity to these nodules. they are hard and freely mobile under the skin. anyone else before I tell the story?

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  17. Fat necrosis? followed by dystrophic calcification?

    M

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  18. Foreign body granuloma?

    M

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  19. M,
    You take the prize today.... But you hit the ring next to the bullseye. This gent came under fire from three enemy combatants at about 20 ft. Impacted bu multie AK rounds and his body armor saved his life. One round destroyed his rifle and gave him a mostly superficial wound distal to the nodules. The nodules are shrapnel from his destroyed rifle. His .45 still worked however, and that allowed him to solve the emergency in a definitive way.

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  20. YES ( emphatically). Medically speaking this is still a FB granuloma ( Irrespective of granuloma formation, because who cares about )

    MU

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  21. Okay, bullseye.

    Frank? You okay?

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  22. Frank must still be battered from wounds he suffered in the previous post. Long range ones from India.

    M

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  23. and yes, he is a Hindu now (@frank)
    mkk

    M

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  24. Hahahaha, Sculptor and Mkk creamed Frank, twasn't pretty, eh Frank ;-)

    Eh ? Eh ? Eh ?

    Your favourite Canuck

    P.S. Canadians have bigger dicks than Yanks

    EVERYONE knows that, even Sarah Palin...

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  25. Palliative Care Doc10:17 PM, September 19, 2011

    So ms1 should have asked if it was a Canadian penis in the picture?

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  26. @911doc: Wouldn't the diagnosis have been easier if it really was a penis? But, sadly I missed the quiz
    And Frank is busy trying to cram up on Scrubs & now, from what I read, House MD! Exams must be approaching!

    @frank: Let's call it a truce. You're running out of ignorant half-ass-wiped comments & now, I couldn't possibly question Dr.House's apprentice, especially since his beloved team lost so horribly. Then again, life is nothing but a cycle. You should know that, your last bout was PMS was such a bitch!

    @mkk: haha

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  27. Your a better man than I am, Grungy Din...
    Now go cure some Lepers or something...

    Frank

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  28. MS1,
    Hey little guy, I've been very busy lately and haven't been able to do silly stuff like this.
    So I'm skimming along and what's with the "Is it an arm or a leg?"

    -SCRN

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