A Suspicious Scaly Rash on a Young Sailor
Look closely at this eruption and consider its distribution. Is the dermatology clinic seeing a "textbook" case here? What's your diagnosis?
You are on virtual rounds today. Look closely at this eruption and consider its distribution. Is the dermatology clinic seeing a "textbook" case here? What's your diagnosis?
You and a fellow in adolescent medicine will attend an adolescent and pediatric dermatology clinic as guest staff. The format is to share a few interesting cases, back and forth.
Patient background: The patient frequents sick call and when he presents yet again, this time with a widespread rash of unique distribution, the ship's MD refers him to the Naval Hospital dermatology clinic.
Observed is a papulosquamous eruption on the trunk; looking closely at the lesions there is scale with collarette, similar to pityriasis rosea, but other features suggest an alternate diagnosis.
The same papulosquamous lesions are seen on his face.
The patient also has papulosquamous lesions on the soles of his feet… yet another unusual distribution that is likely to narrow the differential diagnosis.
Differential diagnosis: tinea versicolor, tinea corporis, exanthematous drug eruption.
Differential diagnosis: guttate psoriasis, parapsoriasis, erythmea multiforme, urticaria.
Differential diagnosis: nummular dermatitis/eczema, secondary syphilis?
Pityriasis rosea seems plausible and so, now, does secondary syphilis, given scale with collarette, a feature similar to both conditions.
What is your diagnosis? tinea versicolor, tinea corporis, exanthematous drug eruption. guttate psoriasis, parapsoriasis, erythmea multiforme, urticaria, nummular dermatitis/eczema, secondary syphilis
Diagnosis: Secondary syphilis. Patient has a history of contact with prostitutes and previous visits to STD clinics. Current rash broke out ~2 wks after most recent exposure.
Suspicion of secondary syphilis confirmed based on timing of appearance of rash and patient's history.
Click through the case study below to meet a young sailor with a suspicious rash who seems to have made more than his share of trips to see the ship's doctor. Can you identify the eruption at a glance? See if you think the dermatology clinic is dealing with a "textbook" case.Dr Jonathan Schneider presents a case from the archive of interesting clinic encounters he had while serving as a physician in the US Navy.
