(BMJ) - A 46-yo African American man w/ uncontrolled DM and HTN presented w/ SOB and confusion. Exam: white, powdery deposits on face and limbs. Labs: BUN=100 mg/dL, Cr=7.3 mg/dL. The skin findings resolved after 10 days of hemodialysis. What caused the powdery substance?
Crystallized urea
Nephrogenic fibrosing dermopathy
Calcinosis cutis
Xerosis
Calciphylaxis
You are correct. Crystallized urea, otherwise known as "uremic frost,” can be seen in patients w/ renal failure. It occurs as a consequence of elevated levels of urea in sweat that precipitates and crystallizes on skin surfaces.
(BMJ) - A 35-yo pregnant woman developed gingival hyperplasia and lost 10 lbs over 5 wks w/ no other symptoms. Labs: leukocytosis, anemia, thrombocytopenia. Images show gums before and after resolution. What is the diagnosis?
Pregnancy-related gingival hypertrophy
HIV infection
Crohn disease
Acute myeloblastic leukemia
Infectious gingivitis
You are correct. This patient had acute myeloblastic leukemia confirmed by bone marrow aspiration. Pregnancy was terminated at around 22 weeks and chemotherapy promptly started. Her gingival hyperplasia improved within 5 days of starting chemotherapy (image A) and, by 51 days, had returned to normal without any odontological intervention (image B). Gingival hyperplasia is associated w/ acute myelomonocytic and monocytic leukemias and necessitates immediate investigation.
(BMJ) – A 40-yo man presented w/ a 6-wk hx of a mildly painful, enlarging ulcer on his lower leg after a trip to Afghanistan. Exam showed a large ulcer and proximal erythematous nodules. What is the diagnosis?
Pyogenic granuloma
Ulceroglandular tularemia
Sporotrichosis
Cutaneous leishmaniasis
Leprosy
You are correct. Cutaneous leishmaniasis due to Leishmania major (which is transmitted by sand fly bites) was confirmed by tissue polymerase chain reaction. This disease is seen frequently among returning military personnel. The patient was treated with intravenous sodium stibogluconate for 20 days.