ABSTRACT
Erythroderma refers to a spectrum of skin diseases resulting in diffuse erythema and scaling encompassing ≥ 90% of the body surface area. The differential diagnosis ranges from primary dermatologic diseases such as atopic dermatitis and psoriasis to potentially deadly causes such as staphylococcal toxic shock syndrome, toxic epidermal necrolysis, and malignancy. Cutaneous T cell lymphoma (CTCL) is an uncommon but highly morbid cause of erythroderma. This non-Hodgkin lymphoma remains a diagnostic challenge due to its variable clinical presentation and varied histologic features. Mycosis fungoides (MF) is the most common form of CTCL. Making a timely diagnosis is challenging as it may mimic inflammatory diseases of the skin including eczema, psoriasis, lichen planus, and cutaneous lupus. We present a case of a 58-year-old man who presented with 5 years of cutaneous symptoms and several months of fevers and night sweats, ultimately diagnosed as MF. Owing to diffuse CD30 positivity, he was a candidate for brentuximab vedotin, an antibody-drug conjugate medication that selectively targets the CD30 antigen. This resulted in an excellent therapeutic response.
Subject(s)
Mycosis Fungoides/diagnosis , Skin Neoplasms/diagnosis , Antineoplastic Agents, Immunological/therapeutic use , Brentuximab Vedotin/therapeutic use , Dermatitis, Exfoliative/etiology , Diagnosis, Differential , Humans , Ki-1 Antigen/analysis , Male , Middle Aged , Mycosis Fungoides/drug therapy , Skin Neoplasms/drug therapySubject(s)
Acute Kidney Injury/diagnosis , Diagnosis, Differential , Granulomatosis with Polyangiitis/diagnosis , Lung Neoplasms/diagnostic imaging , Pneumonia/diagnosis , Acute Kidney Injury/pathology , Aged , Agriculture , Anti-Bacterial Agents/therapeutic use , California , Contrast Media/adverse effects , Cough/etiology , Dyspnea/etiology , Fever/etiology , Humans , Lung Neoplasms/complications , Male , Mexico/ethnology , Piperacillin, Tazobactam Drug Combination/therapeutic use , Tomography, X-Ray Computed , Vancomycin/therapeutic useABSTRACT
A 70-year-old man presented with acute wrist pain concerning for septic arthritis. Shortly thereafter, he developed acute monocular vision loss and was diagnosed with endogenous endophthalmitis. Subsequent imaging revealed numerous visceral abscesses and a mycotic abdominal aortic aneurysm. Cultures, in conjunction with the clinical syndrome, were strongly suggestive of hypervirulent Klebsiella pneumoniae syndrome (hvKP). hvKP syndrome may present with multiple sites of infection or subsequent metastatic spread may develop; the liver, lungs, central nervous system and eye are most commonly involved. Prompt source control and intravenous antibiotic therapy leads to a cure in the majority of patients. This case highlights the risk factors, presentation, management and prognosis of this disease as well as its increasing incidence in North America and Europe.
Subject(s)
Ceftriaxone/administration & dosage , Endophthalmitis/microbiology , Klebsiella Infections/diagnosis , Klebsiella pneumoniae/isolation & purification , Liver Abscess/microbiology , Administration, Intravenous , Aged , Arthritis, Infectious , Ceftriaxone/pharmacology , Diagnosis, Differential , Humans , Klebsiella pneumoniae/drug effects , Male , Treatment OutcomeABSTRACT
Intolerance of ambiguity among medical students is associated with negative attitudes towards psychosocially complex patients. In this paper, the authors evaluated the feasibility of a 3.5-hour workshop aimed at fostering tolerance for ambiguity in medical students through semi-structured interactions with horses that functioned as experiential surrogates for ambiguity. Among 26 first-year medical students who participated in the feasibility assessment, an overwhelming majority rated the workshop as academically valuable and recommended that it be offered again in the future. After feasibility was established, an additional group of 7 first-year medical students and 5 fourth-year students completed Budner's Tolerance of Ambiguity scale before and after the workshop to provide preliminary data on its effectiveness. The post-workshop mean scores on the Budner scale were lower than pre-workshop mean scores, suggesting that students developed greater tolerance for ambiguity following the workshop. This difference was statistically significant among the first-year students, but not among the fourth-year students. Our findings demonstrate that the equine-facilitated workshop is feasible and can potentially help medical students develop greater tolerance for ambiguity.
