Monday, June 04, 2007

Case for Diagnosis

The patient is a 54 yo woman with a 2 week history of a rash on the arms and chest. Two months ago, she had erythema nodosum with atypical features (on her legs). The work-up eventually discovered Crohn's disease. She was started on Asacol around a month ago and around 2 weeks ago developed erythematous papules on arms and anterior chest.

0/E: The new lesions are 6 - 8 mm in diameter erythematous papules with the suggestion of central punctae. The E.N. has resolved.

Lab: Representative lesions were biopied.

Question: What are your thoughts? We will post pathology in around a week.



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4 comments:

  1. AnonymousJune 04, 2007

    The picture reminds me of a patient that I once had with Sweet's syndrome, which I understand can be associated with IBD. Does this patient have any systemic symptoms?

    - Ken Fowler

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  2. AnonymousJune 05, 2007

    Sweet's fits well - presumably the plaques are tender, and patient perhaps febrile? - Ben Barankin

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  3. Amanda OakleyJune 05, 2007

    Target lesions may arise in erythema multiforme (wrong distribution), bullous pemphigoid (too young), Sweet's (best bet in this case I think).

    Mesalazine skin adverse reactions are listed as "Alopecia, psoriasis (rare), pyoderma gangrenosum (rare), dry skin, erythema nodosum, urticaria."

    Amanda Oakley

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  4. AnonymousJune 07, 2007

    Crohns ds might present with EN and erythema multiforme which can take atypical picture.Still diarrhea,EN,EM,Sweets ds could be a presenation of Behcets ds.So please ask about other features of Behcets like orogenital ulcerations,eye problems.Also perform PATHERGY TEST.
    khalifa sharquie

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