A New Planet?
David Elpern MD
Williamstown, MA, USA
on December 8, 2001
The patient is a chronically ill 53 year-old woman with a two months history of lesions on the dorsae of both hands. She is disabled as a result of depression, gastroesophageal reflux disease (GERD) and a past-history of alcoholism.
For the past few months she has been developing lesions on her hands. Her only medications are Premarin, Prilosec and Proventil.
Exam: The patient is a light-complected Caucasian with Type II skin. On the dorsae of both hands are 2.5 - 3 cm plaques with a suggestion of rolled borders and central ulceration. Some areas appear to sequester purulence.
Impression: I favor a neoplastic disease such as multiple giant keratoacanthoma; but also consider blastomycosis-like pyoderma and atypical deep fungal or AFB infection. History does not support these latter two. An incisional biopsy was taken from the margin of one of the lesions and a bacterial culture was obtained.
David Elpern's additional note
The biopsy was confirmed to have a neutrophilic dermatosis. She was later found to have metastatic carcinoma.