tag:blogger.com,1999:blog-9870114.post198273625832302083..comments2024-03-10T08:41:32.400+00:00Comments on VIRTUAL GRAND ROUNDS IN DERMATOLOGY 2.0: 12 yo Boy with Chest Pain and Skin LesionsHumane Medicine Huihttp://www.blogger.com/profile/07113291188306363130noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-9870114.post-20467314921440290272010-05-02T01:26:09.927+00:002010-05-02T01:26:09.927+00:00The excessively high total cholesterol (>600 mg...The excessively high total cholesterol (>600 mg%) coupled with extensive xanthomas clinch the diagnosis of homozygous FH. Although unsightly, the xanthomas themselves have little bearing on the clinical course of this disease, the endpoint of which is arteriosclerosic heart disease. Even so, it would be prudent to treat the child with statins—perhaps multiple agents—to lower the serum cholesterol.<br /><br />As Dr. Lacombe notes, chest pain that worsens with lying supine and improves with sitting up is a classic finding in pericarditis. No mention is made of the presence of a pericardial effusion on the echocardiogram. I wonder about the findings of the dilated left atrium and ventricles. This child might have valvular heart disease—perhaps mitral regurgitation or aortic stenosis, the latter of which is a common finding in homozygous FH. Again, we are given little information about the state of his valves on echo or auscultatory findings. He definitely warrants a consultation with a pediatric cardiologist, if one is available.<br /><br />Given the boy’s age and current status, the prognosis is guarded.<br /><br />In this case, although the dermatologist can render a sound diagnosis, further workup and treatment rest in the hands of the cardiologist.<br /><br />Brian T. Maurer, PA-CBrian T. Maurernoreply@blogger.comtag:blogger.com,1999:blog-9870114.post-14000569783225973142010-05-01T21:02:10.034+00:002010-05-01T21:02:10.034+00:00This is from Roy and Yitzhak Beigel whose referenc...This is from Roy and Yitzhak Beigel whose reference is on the blog:<br /><br />The case itself is interesting yet raises some questions before a management decision can be made:<br /> <br />There is data missing from the physical examination:<br />What are findings upon cardiac and lung auscultation? are the lungs clear? what are his vital signs, especially when he complains of chest pain and shortness of breath.<br />What is the lab workup, especially regarding his CBC and cardiac enzymes?<br />What does the ECG show during his complaints? and what does the entire Echo report say, does he have aortic stenosis?<br />Regarding his cholesterol levels this case resembles a case of FHH - what is the family history, are there any other family members involved?<br /> <br />In regard to management and therapy for both short and long term I think you will find the attached manuscript helpful.Humane Medicine Huihttps://www.blogger.com/profile/07113291188306363130noreply@blogger.comtag:blogger.com,1999:blog-9870114.post-77596226931084089772010-04-28T11:11:20.276+00:002010-04-28T11:11:20.276+00:00Yes, tuberous xanthomata from homozygous fam. hype...Yes, tuberous xanthomata from homozygous fam. hypercholesterolemia. These patients often have significant pericardial effusions which on pericardiocentesis look like liquid gold. The positional chest pain is likely pericarditis from the effusion, and no, not secondary to xanthomata near the coronary ostia.<br /><br />Michael LaCombeMichael A. LaCombehttp://mlacombe@mainegeneral.orgnoreply@blogger.comtag:blogger.com,1999:blog-9870114.post-18350191698367667512010-04-27T19:23:24.516+00:002010-04-27T19:23:24.516+00:00Remarkable case. Difficult to find in the western ...Remarkable case. Difficult to find in the western world where advanced primary health care system guarentees early detection of such cases and less complications.I agree with doctor henry foong, though lesions are quite large but serum lipid control leads to reversal of xanthoma mass.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-9870114.post-14412767777029169022010-04-27T13:29:07.351+00:002010-04-27T13:29:07.351+00:00A classsical case of tuberous xanthomata. Check fa...A classsical case of tuberous xanthomata. Check family history, Do a complete lipid profile and a cardiology consult. Would use oral statins to reduce the cholesterol and triglycerides levels and hopefully dimimish size of xanthoma. Would not treat the xanthoma surgically - they tend to recur.Henry Foonghttps://www.blogger.com/profile/02804592640968503188noreply@blogger.com