MEDICAL ROOM

Friday, November 4, 2011

Spot Diagnosis 021

1:19 PM

bolty

A 57-year-old man with severe abdominal pain presents to a local emergency department (ED)

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Saturday, September 17, 2011

Dermatomyositis is one of a group of muscle diseases known as the inflammatory myopathies, which are characterized by chronic muscle inflammation accompanied by muscle weakness. Dermatomyositis’ cardinal symptom is a skin rash that precedes, accompanies, or follows progressive muscle weakness. The rash looks patchy, with purple or red discolorations, and characteristically develops on the eyelids and on muscles used to extend or straighten joints, including knuckles, elbows, knees, and toes. Red rashes may also occur on the face, neck, shoulders, upper chest, back, and other locations, and there may be swelling in the affected areas. The rash sometimes occurs without obvious muscle involvement. Adults with dermatomyositis may experience weight loss, a low-grade fever, inflamed lungs, and be sensitive to light such that the rash or muscle disease gets worse. Children and adults with dermatomyositis may develop calcium deposits, which appear as hard bumps under the skin or in the muscle (called calcinosis). Calcinosis most often occurs 1-3 years after the disease begins. These deposits are seen more often in children with dermatomyositis than in adults. In some cases of dermatomyositis, distal muscles (muscles located away from the trunk of the body, such as those in the forearms and around the ankles and wrists) may be affected as the disease progresses. Dermatomyositis may be associated with collagen-vascular or autoimmune diseases, such as lupus.

The association between dermatomyositis (and possibly polymyositis) and malignancy has been recognized for a long time. Dermatomyositis is a systemic disorder that frequently affects the esophagus and lungs and, less commonly, the heart. Calcinosis is a complication of dermatomyositis that is observed most often in children and adolescents.

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Case no.2

6:22 AM

gagen

A 56-year-old woman presented with complaints of an ulcerating lesion at the inner corner of right eye for the past 8 months. There had been an off and on history of yellowish discharge from the lesion; occasionally it is blood tinged. She had a history of trauma with a wooden stick at the affected site, 10 months earlier. Clinically, a firm mass could be palpated. Extraocular movements were full. Slit lamp and fundus examination were within normal limits in both eyes. CT scan showing coronal and axial view is shown above.

1. The most probable diagnosis is:
a. sebaceous gland carcinoma
b. canaliculitis (Actinomyces)
c. chronic dacryocystitis with fistula
d. basal cell carcinoma

2. The treatment would be:
a. curettage of canaliculi and Amphoteracin B
b. dacryo-cystorhinostomy with stent
c. incisional biopsy
d. wide excision of the lesion with margin control

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