52 yo with chronic skin infections. Has been told it is all | Figure 1

52 yo with chronic skin infections. Has been told it is all #Hidradenitis-suppurativa. I suspect something else is going on. He declined any biopsies. Has arthralgias and contractures of his fingers.

More about this case

Atypical presentation of breast skin ulcer.

Pt. is 50 yr. old female, presents to Urgent Care with c/o of finding this while in the shower. She doesn’t complain of pain, but says it’s “a little tender and sore”, upon palp. She states that she didn’t even know it was there until she felt it while washing. Hx of hyperlipidemia, GERD, clinically obese BMI (ht - 5”6 wt -200). No diabetes, HTN, auto-immune. Hx of Hidradenitis in right groin/vulva area in 2012, wide excision performed, with development of sinus tract during wound care. Sinus tract has been actively draining since 2012, but her surgeons state it’s too risky to perform another surgery. She is not on any medical management for HS. No other recurrence of HS anywhere since. Wound does not to present with any odor or drainage. A thick yellow slough in center of wound is slightly weepy upon agitation with culture swab. No induration, no suspicious lumps/masses upon breast exam. Pt. has not had mammogram yet. No family Hx of breast cancer. Pt is afebrile, and doesn’t c/o pain. Wound Cx reveals 2+ normal skin flora and rare Proteus Mirabilis. Photos shown are first day thru current, starting with first pic. Bactrim DS is being continued, after susceptibility to Bactrim was confirmed. Pt. Referred to wound care, and mammogram recommended after wound care consult. This is an atypical wound. Proteus Mirabilis seems odd and uncommon in this location. What are your thoughts?

Ideas? 55yo Burmese man

Presents with 2d hx of painful pustules/papules/vesicles on face and chest and axilla, in addition to painful and swollen left temple. Is tachycardic, febrile, and all lesions very tender to touch. Unfortunately no capacity for labs or biopsy. One has to think of temporal arteritis but thoughts about the painful pustules?? Any syndrome standing out to people?

19 year old with subQ nodule in right axilla.

1cm. Fixed to skin. Mild tender (blue arrow). Several smaller nodules superior to this. Previous needle biopsy. Told it was "not anything". Now he has a golduch like a frenulum in the axilla with abduction (orange arrow). This causes pain into the arm.

Large painful lump under axillary.

Smaller similar lump on other side of armpit. No redness or drainage. Is hidradenitis supperativa? Thoughts?

Trending now

A 52-year-old man

Presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman

Presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant

Presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens

Presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family.