Sunday, July 22, 2007
Saturday, June 23, 2007
Clinically, multiple red spots with rim of halo noted over her arms. Full blood count showed leucopenia with lymphocytosis and thrombocytopenia, consistent with viral picture. Dengue IgM was positive.
Monday, March 5, 2007
Wednesday, February 28, 2007
He was treated empirically with IV antibiotic (Cloxacillin and Ceftriaxone). After one week in the ward, and the temperature was still spiking, he developed numerous small papular lesions over the body and more marked over the lower limbs.
On examination, there were monomorphic, skin-colored, small papular eruptions, scattered over the face, body, upper limbs and numerously over the lower limbs (see pictures).
What is it?
We were thinking, more of molluscum contagiosum.
But the paediatricians thought otherwise, ? Gianotti-Crosti syndrome.
Sunday, February 25, 2007
Saturday, February 24, 2007
On examination, there was erythematous and slightly scaly lesion over the malar eminence as well as over the scalp. Similar lesions were also noted over the forearms and the back of trunk with areas of scarring. In addition, there was also scarring alopecia noted.
Friday, February 23, 2007
Clinically, the lesions appeared well-defined, dried and scaly with cracks, on an erythematous base. There were also maculo-papular rashes over the body. There was no scalp involvement or nail changes. Fungal scrapping was negative.
Although from the history, it sounded like contact dermatitis, clinically, the lesions appeared more "psoriatic". Furthermore, the lesions were more extensive and involved other non-exposure sites (body).
?Allergic contact dermatitis.
Anyway, I treated him as having contact dermatitis.
Thursday, February 22, 2007
We are treating her as having some form of photodermatitis or polymorphic light eruption.
She was given Betnovate 1:6 cream, aques cream as emollient and anti-histamine. However, her response was unsatisfactory, with persistent disturbing pruritic lesions. One factor contributing to her condition was, she still works by the roadside and wear T-shirt with short pants despite been advice against doing so.
Any comment or suggestion?
Wednesday, February 21, 2007
Her biopsy was later reported as chronic granulomatous lesion, suggestive of atypical mycobateria infection.
On two weeks follow-up, surprisingly, the lesions had flattened >50% with areas of scaling and crusting.
We extended another two weeks of EES and will be discussing her HPE in the next combine meeting. KIV may need to start on anti-TB if indicated.
Saturday, February 17, 2007
Clinically, the tumor is cauliflower-liked with ulceration and area of bleeding spots.
He was referred to dermatologist for opinion because of the HPE report:
Section showed skin with underlying spindle shaped illed-define lesion. The cells show a storiform pattern of arrangement. The cells have moderately pleomorphic muclei and few mitotic figures are seen. Foamy macrophages are noted with occasional large bizarre cells. The is no necrosis noted. There is no evidence of malignancy in this biopsy. Diagnosis: Benign fibrous histiocytoma.
In view of the clinical findings, this tumour behaved as malignant with evidence of metastasis.
A repeat biopsy was done on 13/2/2007.
Atlas of genetics and cytogenetics in oncology and haematology
Malignant fibrous histiocytoma
Repeat biopsy report:
Sections show skin tissue with underlying dermis. A diffuse cellular lesion is noted in the dermis. The lesion composed of spindle-shaped cells arranged in stori-form pattern. The spindle-shaped to plump cells exhibit mild to moderate pleomorphic vesicular nuclei and prominent nucleoli. Mitotic figures are seen. Infiltration by acute and chronic inflammatory cells is noted.
Immunohistochemical stain: The spindle-shaped cells are positive for vimentin.
Diagnosis: Dermatofibrosarcoma protuberans.