Wednesday, February 4, 2009

Valley Girl

A Filipino woman presents to your Fresno clinic during the summer with these red-violet indurated painful nodules on her shins. Her sed rate is increased.

Challenge: What's the diagnosis?

Related Questions:
1. What's the skin finding called?

Image is in the public domain.

3 comments:

deardoc said...

that looks and sounds like Erythema Nodosum.

EN with elevated Sedimentation rate could be so many things..i really wish some more clues were provided...i think it might e either tuberculosis or coccidiodimycosis..but i'll go with tuberculosis for now considering her origins.

CodeDog said...

Erythema nodosum

The underlying cause is this case is unclear without further test results.

EN can be caused by infections, autoimmune disorders, drug reactions and even some types of cancer.

The most likely cause is some recent infection which has hyper sensitized the immune response to the subcutaneous fat cells.

Ask her if she has started any new medication recently.
Do a pregnancy test.
Absent other symptoms like digestive problems or chest pain and cough;
Check the patient for sarcoidosis and streptococca.

Craig Chen said...

Yes, they are erythema nodosum. I should have specified more the geography. The association with Fresno, California suggests cocci.
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Valley Girl

This is coccidiomycosis caused by the dimorphic fungi Coccidioides immitis or posadasii acquired by inhalation of spores. It is limited to lower desserts of the Western hemisphere (central California, Arizona, New Mexico, west Texas) with a seasonal exposure and extrapulmonary manifestations are more frequent in Filipinos and those of African descent. Most infections are subclinical, but community acquired pneumonia, fatigue (“dessert rheumatism”), and erythema nodosum (shown here) or multiform are possible.

Sources: UpToDate; nlm.nih.gov.