Case 1 - Click here for Text and References
Submitted by: Lyn McDivitt M. Duncan
A 48 year old man presented with nausea/ vomiting, fatigue, and 50 pound weight loss in 4 months. Four months prior he was seen at an OSH for nausea, vomiting and jaundice. ERCP and CT revealed enlargement of the pancreatic head with peripancreatic, celiac and retroperitoneal lymphadenopathy and dilatation of the common bile duct (CBD). FNA of peripancreatic lymph nodes and cytobrush from the CBD were non-diagnostic. A biliary stent was placed to relieve obstructive jaundice. Results of exploratory laparotomy with pancreatic biopsy, retroperitoneal lymph node biopsy and FNA of the common bile duct led to a diagnosis of autoimmune pancreatitis. The lymphadenopathy and symptoms did not respond to treatment with prednisone.
He was referred to MGH with 50 pound weight loss in 4 months, increased nausea and vomiting, fatigue, fever to 103, and erythematous changes to the exploratory laparotomy abdominal incision.
Dermatology was consulted for expanding erythema at the surgical site. The patient first noticed pain and tenderness and small erythematous papules around the surgical site two weeks prior. The erythema slowly expanded and the central area near excision site became exquisitely painful to touch. No significant discharge was identified at the wound site.
A skin biopsy of the abdomen was performed.
Case 2 - Click here for Text and References
Submitted by: David E. Elder
A lesion on the parietal scalp of a 28-year-old female. Reason for consultation. In a few areas, the lesion shows features which suggest to me that it may represent a cellular blue nevus. However, I am concerned about the possibility that it may represent a malignant blue nevus or malignant melanoma.
Case 3 - Click here for Text and References
Submitted by: Bruce R. Smoller
51 y.o. female with a history of NSHD presented with a 2.0 cm erythematous plaque on the back of her right hand. The lesion was tender and centrally crusted. The patient had no systemic symptoms. The clinical impression was foreign body reaction vs. keratoacanthoma vs. follicular abscess.
Case 4 - Click here for Text and References
Submitted by: Janis M . Taube
59 year-old woman with erythematous plaques involving the nose x 3 years, not responding to laser treatments. Patient has a "15 year history of rosacea, rule out rhynophyma, syphilis, other infectious process (TB, histoplasmosis), NK T cell lymphoma".
Pertinent Laboratory Data:
PCR assay for TCRgamma demonstrates a clone. Special stains for PAS, FITE, and Warthin-Starry fail to reveal microorganisms.