September 2021 - Case of the Month
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 48 year old man presented with an asymptomatic rash mainly affecting his trunk and proximal limbs, which had developed over a period of about six weeks. There was no personal or family history of skin problems. The patient had been on allopurinol for many years, and tramadol for about 4 months for back pain. The patient had an office-based job.
There were multiple tumid (firm) red-purple papules / small nodules, predominantly on the trunk.
What is the diagnosis?
With multiple red/purple tumid lesions there is a significant differential, which includes granulomatous conditions (such as sarcoid), a lichenoid drug reaction, and lymphoma. A lesion was excised and sent for urgent analysis, with the list of differentials included on the pathology form so as to help guide the pathologist. Histology showed no granulomas or abnormal lymphocytes, but it did show evidence of a lichenoid reaction.
In lichenoid drug eruptions the reaction can develop weeks or months after the medication is started. The most commonly associated medications are gold, antimalarials, thiazides, ACEI, betablockers, quinine and tramadol.
The patient had their tramadol stopped, and gradually over a period of 3 months the rash resolved.
For more information refer to the chapter on drug reactions.
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 52 year old man presented with a one year history of skin lesions predominantly on his hands, ears and scalp. He was also complaining of painful swollen fingers associated with morning stiffness. There was no family history of skin or joint problem...
A 72 year old man was referred with a rash, predominantly on the legs. The patient was systemically well and the lesions were only mildly symptomatic. The lesions presented as one to several at a time lasting several weeks. They had not res...
Welcome back to the new look PCDS website, and our first case. This lady was referred as a 2-week wait with a changing lesion on the right temple.
A 15 year old lady was referred for a diagnostic opinion for skin changes presenting in birth, affecting the right upper back, shoulder, antecubital fossa and dorsal wrist. The patient was asymptomatic and otherwise well.
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