Dermatological Indications of Disease

99 Pages·2014·8.49 MB·English

by  Richard Darrow

Dermatological Indications of
Disease - Part I
This 56 year old man has a history of headaches, jaw
claudication and recent onset of blindness in his left eye.
Sed rate is 110. He has:
A. Ergot poisoning.
B. Cholesterol emboli.
C. Temporal arteritis.
D. Scleroderma.
E. Mucormycosis.
What does an elevated sed rate indicate?
What causes polyclonal gammopathy?
Alpha-2-chymotrypsin and vitamin D binding protein
Alpha-1-antitrypsin
Alpha-2-macroglobulin
TBG & transcortin
Haptoglobin, ceruloplasm
Transferrin
Alpha fetoprotein
Prebeta lipoprotein (VLDL)
(HDL)Alpha-1-lipoprotein
Beta lipoprotein(LDL)
includes SAA
Complement
Fibrinogen
IgA(beta gamma
IgM bridging)
IgG
Polyclonal gammopathy = infection, chronic liver disease
and collagen vascular disease
Lysozyme = myelo-
monocytic leukemia
(Kidney damage and low K+)
What are the types of large vessel vasculitis?
Large vessel vasculitis:
1. GCA complex = Cranial arteritis
Aortic arch syndrome
Fever/wasting syndrome(FUO)
Polymyalgia rheumatica
2. Takayasu’ arteritis (Pulseless disease) –
age < 40
claudication (arms more than legs)
bruits
arteriogram abnormal
3. Behçets syndrome* (“Old Silk Road” disease)
*affects all size vessels
This patient has antithyroid
antibodies. This is:
• A. alopecia areata.
• B. psoriasis.
• C. tinea.
• D. lichen planus.
• E. syphilis.
Search for Hashimoto’s or
Addison’s or other B8, Q2, Q3,
DRB1, DR3, DR4, DR8 diseases.
This woman was placed on
piroxicam 3 weeks ago. She has
20% of her body involved with
erythema and targetoid lesions.
Her dermatitis was preceeded by
fever, chills, headache and GI
upset. Labs show anemia and
neutropenia. Which is most likely
present?
A. Erythema Multiforme
B. Kawasaki’s disease
C. SJS/Toxic Epidermal Necrolysis
D. Systemic Lupus Erythematosis.
E. Staphylococcal Scalded Skin
Syndrome
SJS and TEN are almost invariably due to drugs.
Drugs causing SJS/TEN
7.
Drugs: West: 1. oxicam NSAIDs, ie perioxicam (Feldene)
2. sulfas
East: 1. carbamazepine (Tegretol) – HLA - B*1502
2. allopurinol – HLA - B*5801
The Fas ligand, a member of the TNF family, binds to the
receptor (FasR) creating cell death. Granzyme B from
cytotoxic T cells also plays a role, as does granulysin.
This woman with an elevated CPK has a chief complaint
of: A. itching. B. joint pain. C. muscle weakness.
D. cold fingers. E. vomiting.
Medscape
Remember the association with ovarian, breast, GI and lung cancer!
May be drug induced – ie. hydroxyurea, penicillamine, statins,
cyclophosphamide, etanercept
What is the conjectured cause of
this condition?
A.
Demodex mite (Bacillus olernius)
B. Corynebacterium
C. Pityrosporum
D. Borrelia
E. Tinea
Many have SIBO* and
respond to rifaximin.
Painting by Ghirlandaio
What would you tell this patient?
Keratopathy. Corneal melting!
Corneal vascularization and thinning.
Associated with PD.
What are the causes of flushing?
*Small intestional bacterial overgrowth
A 25 y/o Ethiopian female
presents with the following
eye changes. She initially
had white nodules form in
the upper eye lid. This is:
A. allergic conjunctivitis.
B. Shipyard disease.
C. keratoconjunctivitis sicca.
D. trachoma.
E. Acanthamoeba.