45 years old lady presented with fever of 5 days duration, associated with chills, rigors, nausea, and bodyache. There was history of dengue outbreak in neighborhood. At day 5, fever resolved and the above rashes appeared mostly over her arms.
A 70 years old man was referred to the clinic for further management of multiple pruritic rashes over the body and lower limbs of two years duration.
The lesions over the body and lower limbs appeared well-demarcated erythematous rashes with scaling and excoriation. In addition, he has generalized skin dryness (xerosis).
I would have dismissed the case as 'another chronic eczema', until I find these lesions over the anterior chest.
A large ring-like lesion with central paling. There was reduced pin-prick sensation.
He also has this hand appearance, fixed flexion deformities of the right 4th and 5th fingers; suggesting of an ulna nerve lesion. The ulna nerve was thick on palpation. In addition, he has sparce eyebrows.
Slit-skin smears confirmed the diagnosis.
13 months old baby boy was admitted to the ward for prolonged fever. Clinically, he has hepato-splenomegaly. Full blood count showed pancytopenia. Peripheral blood film and the bone marrow aspirate were unremarkable. "Biohazard" screenings were all negative. Blood C&S has no growth and the rest of the investigations were unremarkable.
27 years old gentleman presented with the above erythematous rashes over the malar region and alopecia of one year duration. There was no photosensitivity, oral ulcer or joint pain. Review of other system was unremarkable.
50 years old gentleman, presented to me with the above lesions over his hands and feet of one month duration. He gave history of washing the floor mat with concentrated bleach solution three days before he started developing such lesions. He also stepped on the mat as well.
46 years old lady presented with the above very pruritic lesions over the body of two months duration. She is a hawker selling Char Koay Teow by the road side. On examination, there were extensive papular lesions over the forearms, lower limbs, neck and body especially over the sun exposed areas.
50 years old gentleman, presented with right gluteal swelling of one year duration. The swelling bled easily on physical contact. He had symptoms of anaemia with loss of weight but normal apetite.
Update (2/3/2007):
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.
14 years old girl, had the above lesions since birth.
45 years old gentleman presented with the above pruritic lesion over the scrotum. Fungal scrapping was negative.
This eight years old boy has the above non-pruritic scalp lesions since infancy. He currently presented because the mother noted significant hair loss of one month duration. The lesions are very scaly plague with ill-defined borders. Wood's lamp and fungal scrapping were negative.
This 9 years old girl, presented with the above non-pruritic lesion of 2 months duration. It is a well-defined, slightly erythematous and scaly lesion. Wood's lamp was negative and fungal scrapping was negative.
30 years old man presented with the above lesions over the supra-pubic/base of penis since the age of 18 years old (12 years). He denied history of sexual exposure when he first had the lesions.
65 years old lady presented with the above lesions over the face of 6 months duration.
The same lady with ?deep fungal infection (Derm round 4, case 2), was discharged and followed up in the clinic. The initial swab C&S grew Staphylococcus aureus (Sensitive to Cloxacillin). She was treated earlier with IV Unasyn and Metronidazole for one week. She had also been given two weeks of oral Cloxacillin.
20 years old gentleman presented with the above slightly painful, pruritic and smelly lesions over the the soles of three days duration. He is a kitchen helper.
25 years old lady presented with the above lesions over the posterior neck region of 5 years duration.
25 years old man presented with the above lesions of three weeks duration.
58 years old lady, with history of right breast CA and mastectomy done, developed the above lesions after given two cycles of chemotherapy.
65 years old man presented with the above painful lesions over the anterior chest wall with small vesicles and discharges. He was told by the GP that it was shingles. Patient was very concerned and decided to seek 2nd opinion.
29 years old guy, presented with the above non-pruritic rashes over three weeks duration over the body, first started over the left shin.
25 years old lady presented with the above pigmented lesions over the back of three years duration, which were non-pruritic.
The above lesions were noted on the body of a 55 years old man. He is asymptomatic. He said such lesions had appeared on the body since he was teenage.
29 years old gentleman, presented with the above pruritic lesions of two years duration. He has been applying numerous creams he took from GP clinics as well as bought from the phamarcies.
39 years old gentleman, with long-standing DM of more than 10 years, presented with the above lesions of 3 years duration. He is asymptomatic.
