A New Planet?

Presented by

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.

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