Thursday, December 28, 2006

Unusual Case

This 53 yo man presented with a three week history of a pustular eruption on the left small finger. It began as a papule and slowly enlarged.
History reveals that he has a farm with 500 sheep. He has also been exposed to cats and dressed a deer around a month ago.

Diagnostic tests were done.





Follow-up: The KOH prep was positive. The fungal culture is positive at ten days. Thus, this is inflammatory tinea manus. Await fungal culture for typing of dermatophyte. Resolved with dilute Clorox soaks and 2% ketoconazole cream in one week.

12 days after initial visit.

5 comments:

  1. My simple diagnostic test for this man is a KOH. Omid

    ReplyDelete
  2. I vote for orf. See(http://images.google.com/imgres?imgurl=http://www.stanford.edu/group/virus/pox/2004vanya/orf1.jpg&imgrefurl=http://www.stanford.edu/group/virus/pox/2004vanya/orf.html&h=200&w=300&sz=35&hl=en&start=3&tbnid=Iq_GI5UTAGty9M:&tbnh=77&tbnw=116&prev=/images%3Fq%3Dorf%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DG)
    If so, he has two more weeks to go until spontaneous resolution.
    ---Rick Sontheimer

    ReplyDelete
  3. This is kerion of animal origin that might affect non hairy skin.
    Herpes simplex not related to the job of the patient might be a diagnosis but unusual of 3weeks duration.

    khalifa sharquie

    ReplyDelete
  4. Nice case...according to the patient's job the fungal infection must be looked for by direct KOH test...If negative result I thing the case go towards dermatitis repens(acrodermatitis continua)..As disease start in distal digit, localized pustules, unilateral, involve the nail, crusted borders with red denuded area... Thanks

    ReplyDelete
  5. The first photo showed clearly the annular distribution and the central clearance which are quite characteristic of dermatophyte infection. Although the pustular presentation is unusal but it is not against this diagnosis especially in that of animal origin like this case
    Muhsin Aldhalimi

    ReplyDelete

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