Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 38.571
Filtrar
2.
N Z Med J ; 134(1531): 55-62, 2021 03 12.
Artículo en Inglés | MEDLINE | ID: mdl-33767487

RESUMEN

AIMS: The management of a macroscopically normal appendix during diagnostic laparoscopy depends on the accuracy of surgeons' intra-operative assessments. This study aims to determine the accuracy of this assessment and identify factors affecting it. METHODS: We reviewed appendicectomies on adult patients at Waikato District Health Board in 2017. The primary outcome was the agreement between the operative assessment and the gold standard histopathologic assessment. Secondary outcomes were predictors of this agreement. RESULTS: 420 patients were included. Among 74 appendixes assessed as normal by surgeons, 16 (21.6%) had appendicitis on histology. Surgeons assessed 346 appendixes as inflamed; however, 22 (6.3%) were revealed to be histologically normal. Only 2 of the 14 appendiceal neoplasms on histology were identified at the time of laparoscopy. Overall, there was disagreement in 9.1% of cases. This yielded a kappa of 0.69, indicating moderate inter-rater reliability. An inflamed appendix was significantly more likely to be falsely assessed as normal by non-trainee registrars, in female patients and in patients with a pre-operative ultrasound. A pre-operative computerised tomography scan (CT) decreased the odds of false negative operative diagnoses, but it increased the odds of false positives. CONCLUSIONS: Macroscopic assessment of the appendix lacks accuracy and may be challenging in certain groups of operators and patients.


Asunto(s)
Apendicitis/diagnóstico , Errores Diagnósticos/estadística & datos numéricos , Periodo Intraoperatorio , Adolescente , Adulto , Apendicectomía , Apendicitis/cirugía , Auditoría Clínica , Competencia Clínica , Femenino , Humanos , Laparoscopía , Masculino , Persona de Mediana Edad , Nueva Zelanda , Estudios Retrospectivos , Adulto Joven
4.
Mayo Clin Proc ; 96(4): 952-963, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33714592

RESUMEN

OBJECTIVE: To describe the place and cause of death during the coronavirus disease 2019 (COVID-19) pandemic to assess its impact on excess mortality. METHODS: This national death registry included all adult (aged ≥18 years) deaths in England and Wales between January 1, 2014, and June 30, 2020. Daily deaths during the COVID-19 pandemic were compared against the expected daily deaths, estimated with use of the Farrington surveillance algorithm for daily historical data between 2014 and 2020 by place and cause of death. RESULTS: Between March 2 and June 30, 2020, there was an excess mortality of 57,860 (a proportional increase of 35%) compared with the expected deaths, of which 50,603 (87%) were COVID-19 related. At home, only 14% (2267) of the 16,190 excess deaths were related to COVID-19, with 5963 deaths due to cancer and 2485 deaths due to cardiac disease, few of which involved COVID-19. In care homes or hospices, 61% (15,623) of the 25,611 excess deaths were related to COVID-19, 5539 of which were due to respiratory disease, and most of these (4315 deaths) involved COVID-19. In the hospital, there were 16,174 fewer deaths than expected that did not involve COVID-19, with 4088 fewer deaths due to cancer and 1398 fewer deaths due to cardiac disease than expected. CONCLUSION: The COVID-19 pandemic has resulted in a large excess of deaths in care homes that were poorly characterized and likely to be the result of undiagnosed COVID-19. There was a smaller but important and ongoing excess in deaths at home, particularly from cancer and cardiac disease, suggesting public avoidance of hospital care for non-COVID-19 conditions.


Asunto(s)
Causas de Muerte/tendencias , Cardiopatías/mortalidad , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Neoplasias/mortalidad , Casas de Salud/estadística & datos numéricos , Adulto , Anciano de 80 o más Años , /mortalidad , Errores Diagnósticos/mortalidad , Errores Diagnósticos/estadística & datos numéricos , Inglaterra/epidemiología , Femenino , Cuidados Paliativos al Final de la Vida/estadística & datos numéricos , Mortalidad Hospitalaria/tendencias , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Gales/epidemiología
6.
J Med Syst ; 45(4): 48, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-33646459

RESUMEN

Early identification of patients with life-threatening risks such as delirium is crucial in order to initiate preventive actions as quickly as possible. Despite intense research on machine learning for the prediction of clinical outcomes, the acceptance of the integration of such complex models in clinical routine remains unclear. The aim of this study was to evaluate user acceptance of an already implemented machine learning-based application predicting the risk of delirium for in-patients. We applied a mixed methods design to collect opinions and concerns from health care professionals including physicians and nurses who regularly used the application. The evaluation was framed by the Technology Acceptance Model assessing perceived ease of use, perceived usefulness, actual system use and output quality of the application. Questionnaire results from 47 nurses and physicians as well as qualitative results of four expert group meetings rated the overall usefulness of the delirium prediction positively. For healthcare professionals, the visualization and presented information was understandable, the application was easy to use and the additional information for delirium management was appreciated. The application did not increase their workload, but the actual system use was still low during the pilot study. Our study provides insights into the user acceptance of a machine learning-based application supporting delirium management in hospitals. In order to improve quality and safety in healthcare, computerized decision support should predict actionable events and be highly accepted by users.


Asunto(s)
Algoritmos , Toma de Decisiones Clínicas , Delirio/diagnóstico , Errores Diagnósticos/estadística & datos numéricos , Aprendizaje Automático/estadística & datos numéricos , Australia , Diagnóstico Diferencial , Registros Electrónicos de Salud/normas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Escalas de Valoración Psiquiátrica
7.
Medicine (Baltimore) ; 100(8): e23833, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33663042

RESUMEN

ABSTRACT: While chest CT provides important clue for diagnosis of miliary tuberculosis (TB), patients are occasionally missed on initial CT, which might delay the diagnosis. This study was to evaluate the clinical and radiological characteristics of radiologically missed miliary TB.Total 117 adult patients with microbiologically confirmed miliary TB in an intermediate TB-burden country were included. 'Missed miliary TB' were defined as the case in which miliary TB was not mentioned as a differential diagnosis in the initial CT reading. Clinical characteristics and radiologic findings including the predominant nodule size, demarcation of miliary nodules and disease extent on CT were retrospectively evaluated. Findings were compared between the missed and non-missed miliary TB groups. Multivariable analyses were performed to determine independent risk factors of missed miliary TB.Of 117 patients with miliary TB, 13 (11.1%) were classified as missed miliary TB; these patients were significantly older than those with non-missed miliary TB (median age, 71 vs 57 years, P = .024). There was a significant diagnostic delay in the missed miliary TB group (P < .001). On chest CT, patients with missed miliary TB had a higher prevalence of ill-defined nodules (84.6% vs 14.4%; P < .001), miliary nodule less than 2 mm showing granular appearance (69.2% vs 12.5%; P < .001), and subtle disease extent (less than 25% of whole lung field, 46.2% vs 8.7%; P < .001). Multivariable analysis revealed that only CT findings including ill-defined nodule (Odd ratios [OR], 15.64; P = .002) and miliary nodule less than 2 mm (OR, 10.08; P = .007) were independently associated with missed miliary TB.Approximately 10% of miliary TB could be missed on initial chest CT, resulting in a delayed diagnosis and treatment. Caution is required in patients with less typical CT findings showing ill-defined miliary nodules less than 2 mm showing granular appearance and follow-up CT might have a benefit.


Asunto(s)
Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/patología , Factores de Edad , Anciano , Anciano de 80 o más Años , Diagnóstico Tardío , Errores Diagnósticos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Centros de Atención Terciaria , Tomografía Computarizada por Rayos X , Tuberculosis Miliar/diagnóstico por imagen
8.
Pediatr Infect Dis J ; 40(4): e159-e161, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33710982

RESUMEN

Multisystem inflammatory syndrome in children following severe acute respiratory syndrome coronavirus 2 infection is characterized by fever, elevated inflammatory markers, and multisystem organ involvement. Presentations are variable but often include gastrointestinal symptoms. We describe 5 children with fever and gastrointestinal symptoms initially concerning for multisystem inflammatory syndrome in children who were ultimately diagnosed with bacterial enteritis, highlighting the diagnostic challenges presented by the severe acute respiratory syndrome coronavirus 2 pandemic.


Asunto(s)
Infecciones Bacterianas/diagnóstico , Enteritis/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Infecciones Bacterianas/microbiología , Biomarcadores , Niño , Preescolar , Diagnóstico Diferencial , Errores Diagnósticos , Enteritis/microbiología , Femenino , Hospitalización , Humanos , Masculino , Evaluación de Síntomas
9.
Ann R Coll Surg Engl ; 103(3): 203-207, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33645277

RESUMEN

INTRODUCTION: Patients with suspected appendicitis remain a diagnostic challenge. The aim of this study was to validate risk prediction models, and to investigate diagnostic accuracy of ultrasonography and computed tomography (CT) in adults undergoing appendicectomy. METHODS: A retrospective case review was performed of patients aged 16-45 years having an appendicectomy between January 2019 and January 2020 at a tertiary referral centre. Primary outcomes were the accuracy of a high risk appendicitis risk score and ultrasonography and CT imaging modalities compared with histological reports following appendicectomy. RESULTS: A total of 206 patients (52% female) were included in the study. Removal of a histologically normal appendix was equally likely in men and women (13.1% vs 11.2% respectively, relative risk: 1.17, 95% confidence interval: 0.56-2.44, p=0.674). A high risk appendicitis score correctly identified 84.0% (79/94) of cases in men and 85.9% (67/78) of cases in women. Ultrasonography was reported as equivocal in 85.7% (18/21) of low risk women and 59.0% (23/39) of high risk women. CT correctly detected or excluded appendicitis in 75.0% (6/8) of low risk women and 88.5% (23/26) of high risk women. CONCLUSIONS: This study suggests that risk prediction models may be useful in both women and men to identify appendicitis. Ultrasonography gave high rates of equivocal results and should not be relied on for the diagnosis of appendicitis. CT is a highly accurate diagnostic tool and could be considered in those at low risk where clinical suspicion remains to reduce negative appendicectomy rates.


Asunto(s)
Apendicitis/diagnóstico por imagen , Apéndice/patología , Reglas de Decisión Clínica , Adolescente , Adulto , Apendicectomía , Neoplasias del Apéndice/patología , Apendicitis/patología , Apendicitis/cirugía , Errores Diagnósticos , Reacciones Falso Positivas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tumores Neuroendocrinos/patología , Readmisión del Paciente , Estudios Retrospectivos , Factores Sexuales , Tomografía Computarizada por Rayos X , Ultrasonografía , Adulto Joven
10.
Anticancer Res ; 41(3): 1579-1586, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33788752

RESUMEN

BACKGROUND/AIM: Histological changes induced by neoadjuvant chemotherapy (NAC) have rarely been reported in histological subtypes other than ovarian high-grade serous carcinoma (HGSC). CASE REPORT: We report a 49-year-old woman whose tumors in interval debulking surgery (IDS) specimen exhibited prominent papillary growth pattern and severe nuclear pleomorphism due to NAC. In the initial microscopic examination, ovarian HGSC was the most likely candidate; however, immunostaining results were not compatible with HGSC. We detected areas resembling mucinous cystadenoma and borderline tumor, and finally diagnosed this case as ovarian mucinous carcinoma. CONCLUSION: Although the tumor mimicked histologically HGSC, its clinical features differed from those of advanced-stage HGSC. It is important for pathologists to recognize NAC-induced histological changes, be aware of the diagnostic mimics and pitfalls, and to identify the correct histological subtype by considering the patient's previous history, clinical features, preoperative imaging findings, and histological features.


Asunto(s)
Adenocarcinoma Mucinoso/tratamiento farmacológico , Cistadenocarcinoma Seroso/patología , Neoplasias Ováricas/tratamiento farmacológico , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/patología , Quimioterapia Adyuvante/efectos adversos , Cistadenocarcinoma Seroso/diagnóstico , Errores Diagnósticos , Femenino , Humanos , Persona de Mediana Edad , Terapia Neoadyuvante/efectos adversos , Neoplasias Ováricas/patología , Proteínas WT1/análisis
11.
N Z Med J ; 134(1530): 30-37, 2021 02 19.
Artículo en Inglés | MEDLINE | ID: mdl-33651775

RESUMEN

AIM: To investigate the outcomes and effect of a multidisciplinary 'see and treat' pigmented lesion clinic, run jointly by dermatology and general surgery, on the diagnosis and treatment of melanoma at Auckland District Health Board (DHB). METHOD: All patients attending the newly established Pigmented Lesion Clinic (PLC) between 1 March 2019 and 31 August 2019 were included in the study. They were compared against a retrospective cohort of patients seen for suspected or biopsy-proven melanomas during the same corresponding period in 2016. RESULTS: 251 new patients attended the PLC, compared to 148 new patients seen at Auckland DHB in 2016. There was a significant reduction in proportion of pigmented lesions requiring biopsy (35.2% vs 64.3%, p<0.001), with a benign-to-malignant ratio of 2.4:1. Fifty-three melanomas were treated through the PLC, with a significant reduction in mean waiting time from referral to first specialist assessment (22.6 vs 35.1 days, p=0.038), and from referral to wide local excision (50.6 vs 99.1 days, p<0.001). 86.5% of patients received full skin check, from which additional skin malignancies were detected in 1-per-5.3 patients. CONCLUSION: The novel PLC model has led to reduction in unnecessary excisional biopsies of benign pigmented lesions, while streamlining and improving timely access to specialist review and surgical treatment for patients with melanomas.


Asunto(s)
Melanoma/diagnóstico , Melanoma/patología , Nevo Pigmentado/patología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Instituciones de Atención Ambulatoria , Dermatología/métodos , Errores Diagnósticos , Femenino , Humanos , Masculino , Melanoma/cirugía , Persona de Mediana Edad , Modelos Estadísticos , Invasividad Neoplásica , Nueva Zelanda , Valor Predictivo de las Pruebas , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos , Neoplasias Cutáneas/cirugía , Adulto Joven
12.
J Med Case Rep ; 15(1): 99, 2021 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-33648548

RESUMEN

BACKGROUND: Dermoid cysts are well-known lesions that manifest as subcutaneous tumors around the lateral sides of the eyebrows in young patients. Computed tomography or magnetic resonance imaging (MRI) is often performed to confirm the diagnosis. On the other hand, a lipoma is usually a circular lesion, which is sometimes observed in the upper part of the face. The signals of both T1-weighted and T2-weighted images of MRI of a lipoma are, in general, relatively highly homogenous, and the signals decrease in fat-suppressed images. Therefore, differential diagnosis between a dermoid cyst and a lipoma is usually made with MRI, especially based on fat-suppressed images. Here, we present a case of misdiagnosis of a dermoid cyst as a lipoma because of atypical magnetic resonance images. CASE PRESENTATION: We report a case of a 24-year-old Japanese woman with a dermoid cyst around the lateral edge of the eyebrow. The cyst had been gradually increasing in size for the past 2 years. On MRI, it showed high internal signals on T1- and T2-weighted images. However, the signal intensity decreased homogeneously in the fat-suppressed T2-weighted images. The observed tumor had a yellowish appearance under the endoscope. On the basis of these findings, the lesion was considered a lipoma until it ruptured intraoperatively. The pathological diagnosis confirmed it to be a dermoid cyst. CONCLUSION: Some dermoid cysts contain lipid-rich liquid, and these may be misdiagnosed as lipomas by MRI. When a tumor is located at a common site for a dermoid cyst, the MRI images should be validated carefully if it appears like a lipoma, and the differential diagnosis should be considered carefully.


Asunto(s)
Quiste Dermoide/diagnóstico por imagen , Quiste Dermoide/diagnóstico , Quiste Dermoide/patología , Diagnóstico Diferencial , Errores Diagnósticos , Femenino , Humanos , Lipoma/diagnóstico , Lipoma/diagnóstico por imagen , Imagen por Resonancia Magnética , Adulto Joven
13.
Virus Res ; 296: 198340, 2021 04 15.
Artículo en Inglés | MEDLINE | ID: mdl-33592214

RESUMEN

Knowledge of viral load is essential to formulate strategies for antiviral treatment, vaccination, and epidemiological control of COVID-19. Moreover, identification of patients with high viral loads can also be useful to understand risk factors such as age, comorbidities, severity of symptoms and hypoxia, to decide on the need for hospitalization. Several ongoing studies are analyzing viral load in different types of samples and evaluating its relationship with clinical outcomes and viral transmission pathways. However, in a great number of emerging studies, cycle threshold (Ct) values alone are often used as viral load indicators, which may be a mistake. In this study, we compared tracheal aspirate with nasopharyngeal swab samples obtained from critically ill COVID-19 patients and here we report how the raw Ct can lead to misinterpretation of results. Furthermore, based on analysis of nasopharyngeal swab samples we propose a method to reduce evaluation errors that could occur from using raw Ct data. Based on these findings, we show the impact that normalization of Ct values has on interpretation of SARS-CoV-2 viral load from different biological samples.


Asunto(s)
/virología , Errores Diagnósticos , Nasofaringe/virología , Carga Viral , /diagnóstico , Humanos , ARN Viral/análisis , Reacción en Cadena en Tiempo Real de la Polimerasa
15.
Radiol Clin North Am ; 59(2): 279-290, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33551087

RESUMEN

Chest computed tomography (CT) is the modality of choice for mediastinal imaging. The high-resolution images provided by multi-detector CT result in routine visualization of normal anatomic structures, which can be confused with pathology. In addition, many mediastinal abnormalities are discovered incidentally, with a routine chest CT protocol which may be insufficient for definite diagnosis. Awareness of the spectrum of potential pitfalls of mediastinal imaging, artifacts related to flow, motion, and solutions to mitigate these problematic issues is important in accurate interpretation. The purpose of this review is to highlight and discuss potential pitfalls in the imaging of the mediastinum.


Asunto(s)
Errores Diagnósticos/prevención & control , Diagnóstico por Imagen/métodos , Neoplasias del Mediastino/diagnóstico por imagen , Humanos , Mediastino/diagnóstico por imagen
16.
Medicine (Baltimore) ; 100(6): e24699, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578605

RESUMEN

RATIONALE: Pulmonary artery intimal sarcoma is a rare tumor with exceptionally high mortality and easily misdiagnosed as pulmonary thromboembolism pulmonary thromboembolism (PTE) due to the nonspecific clinical presentation and symptom. Misdiagnosis or untimely diagnosis makes the disease progress to an advanced stage and eventually leads to a poor prognosis. PATIENT CONCERNS: A 37-year-old Chinese female presented with chest tightness and dyspnea for 3 months. Echocardiography and chest computed tomography revealed an intraluminal obstruction of the pulmonary arteries. Tests of serum tumor makers showed slight elevation for carbohydrate antigen-125, and α-fetoprotein. PTE was suspected according to the radiological and laboratory findings. DIAGNOSIS: Microscopic findings of the presumed thrombus showed prominent myxoid and edematous background with atypical spindled cells and curvilinear vascularity. Immunohistochemical staining demonstrated that the atypical spindled cells were positive for vimentin but negative for CK, S100, SMA, desmin, CD68, STAT6, CD34, ß-catenin, ALK-p80, p53, and MDM2. According to the radiological and pathological findings, the diagnosis of fibrosarcoma of pulmonary artery was made. INTERVENTIONS: The patient underwent surgical resection and the mass was excised as completely as possible. OUTCOME: Follow-up information showed no evidence of recurrence or metastasis after 3 months postresection. LESSONS: Because of the low incidence rate, nonspecific clinical symptoms, and radiological findings, primary fibrosarcoma of the pulmonary artery is commonly misdiagnosed as PTE. Pathological examination is necessary to confirm the diagnosis.


Asunto(s)
Fibrosarcoma/diagnóstico , Arteria Pulmonar/diagnóstico por imagen , Embolia Pulmonar/diagnóstico , Túnica Íntima/patología , Adulto , Cuidados Posteriores , Grupo de Ascendencia Continental Asiática/etnología , Antígeno Ca-125/metabolismo , Errores Diagnósticos/prevención & control , Errores Diagnósticos/estadística & datos numéricos , Ecocardiografía/métodos , Femenino , Fibrosarcoma/sangre , Fibrosarcoma/patología , Fibrosarcoma/cirugía , Humanos , Embolia Pulmonar/patología , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Vimentina/metabolismo , alfa-Fetoproteínas/metabolismo
17.
BMJ Case Rep ; 14(2)2021 Feb 08.
Artículo en Inglés | MEDLINE | ID: mdl-33558384

RESUMEN

Morgagni's hernia (MH) can be diagnosed by different utilities, but all these methods are not always 100% accurate. Three-dimensional (3D) reconstruction model could be helpful in better understanding the important anatomical structures. We report a case of MH who was once misdiagnosed as diaphragmatic eventration at the other institution and we offered laparoscopic repair according to the 3D reconstruction model. Our case highlights that 3D reconstruction model could be a useful supplementary tool in the diagnosis and preoperative assessment for patients with MH especially when it is confused in diagnosis in clinical practice.


Asunto(s)
Hernias Diafragmáticas Congénitas/diagnóstico por imagen , Imagenología Tridimensional , Tomografía Computarizada por Rayos X , Anciano , Errores Diagnósticos , Eventración Diafragmática/diagnóstico , Eventración Diafragmática/cirugía , Femenino , Hernias Diafragmáticas Congénitas/patología , Hernias Diafragmáticas Congénitas/cirugía , Humanos , Laparoscopía , Cuidados Preoperatorios/métodos
18.
Ann R Coll Surg Engl ; 103(2): e59-e64, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33559550

RESUMEN

Aggressive angiomyxoma is a rare mesenchymal tumour, primarily arising in the soft tissue of the pelvis and perineum in women of reproductive age. There is a paucity of evidence on optimal management because of the rarity of these tumours, but the consensus has been for surgical excision. We present the case of a 65-year-old woman who was admitted with left-sided buttock pain and initially diagnosed with a perianal abscess. She underwent examination under anaesthesia rectum with surgical excision of the lesion, subsequent histopathological and immunochemical analysis was suggestive of aggressive angiomyxoma. To complement our case report, we also present a literature review focusing on aggressive angiomyxoma in the ischioanal fossa (also known as the ischiorectal fossa) with only eight cases of primary aggressive angiomyxoma involving the ischioanal fossa documented to date. The primary aims of this case report and literature review are to familiarise clinicians with the clinical, histopathological and immunochemical features of these tumours, and to increase appreciation that despite the rarity of aggressive angiomyxoma, it might be considered in the differential diagnosis of ischioanal lesions.


Asunto(s)
Mixoma/diagnóstico , Perineo/patología , Posmenopausia , Absceso/diagnóstico , Anciano , Enfermedades del Ano/diagnóstico , Errores Diagnósticos , Tacto Rectal , Femenino , Humanos , Imagen por Resonancia Magnética , Mixoma/patología , Mixoma/cirugía , Neoplasia Residual , Perineo/diagnóstico por imagen , Perineo/cirugía , Resultado del Tratamiento
20.
J Med Case Rep ; 15(1): 80, 2021 Feb 17.
Artículo en Inglés | MEDLINE | ID: mdl-33593424

RESUMEN

INTRODUCTION: Lichen simplex chronicus has been defined as a localized skin condition characterized by thickening, hyperpigmentation and accentuated skin markings from chronic itching and from repeated scratching. The affected skin area is usually described as demarcated, and often circumscribed. It has even been defined as a "psychogenic pruritic disorder". The idea of a neurological component has also been suggested, hence the term 'neurodermatitis circumscripta'. However, the pathophysiology of this condition remains unclear. Several associations and etiologies have been reported in literature, including strong links with mental disorders-anxiety and obsessive compulsive disorder to be specific. We report this case, most importantly, to highlight the value of an open-minded approach to patients and the 'old-fashioned' physician character of empathy, the skill of detailed history taking and physical examination, and lastly to suggest that lichen simplex chronicus may not always present as a localized, 'circumscripta' or demarcated area of skin. CASE DESCRIPTION: When a sixty-five year-old Caucasian female presented to our clinic agitated, intensely scratching her entire body and complaining of severe pruritus, an open-minded detailed approach during history taking and physical examination led to the working diagnosis of diffuse lichenification from chronic scratching secondary to a "possible" cutaneous disorder. Her medical history was unremarkable, but her psychiatric history was significant for Anxiety disorder. She remained on her anxiolytic medication. Her presenting symptom was reported to have persisted for more than 9 months. Review of previous unremarkable lab results and a remarkable findings on detailed skin inspection led to an empiric, trial regimen consisting of three topical preparations: an anti-pruritic-to break the itch-scratch cycle, anti-inflammatory-to curb any inflammatory/immune response and a 'last-ditch' scabicidal application. Follow-up was scheduled, but the patient called the office requesting an earlier follow up appointment. The lesions had significantly improved and the hyper-pigmented, indurated and escoriated skin appearance had resolved; and most importantly, the pruritus. CONCLUSION: Thus we conclude that lichen simplex chronicus may not always present as circumscribed or localized area of skin as currently noted in literature. Also, in patients with psychiatric conditions including anxiety and obsessive-compulsive disorder in particular, effort should be made to avoid stereotyping their presentation as part of their mental disorder spectrum. The value of detailed history and physical examination, mixed with empathy is highlighted. We make our recommendation considering the profound turnaround in the patient's condition and quality of life after several months of emotional and psychological suffering.


Asunto(s)
Trastornos de Ansiedad/complicaciones , Neurodermatitis/diagnóstico , Prurito/diagnóstico , Escabiosis/complicaciones , Anciano , Errores Diagnósticos , Femenino , Humanos , Neurodermatitis/tratamiento farmacológico , Neurodermatitis/parasitología , Prurito/tratamiento farmacológico , Prurito/parasitología , Escabiosis/tratamiento farmacológico
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...