Infections That Bit Me

Melissa Piliang presents intriguing cases of infectious diseases that exhibit unexpected diagnoses. She highlights a 42-year-old Vietnamese immigrant with painful lower leg nodules, initially thought to be erythema nodosum, but later confirmed to be erythema induratum associated with latent tuberculosis after further history revealed her family's history of TB. Another case involves a post-transplant patient with suspected graft-versus-host disease, which turned out to be a misdiagnosis as the patient was found to have disseminated strongyloidiasis. Piliang also discusses a 70-year-old man with cellulitis who had a rare infection from the algae Protopheca, leading to a poor prognosis due to immunosuppression. A case of crusted scabies mistaken for frontal fibrosing alopecia showcases how uncommon presentations can lead to misdiagnosis. She emphasizes the importance of thorough patient history and repeat biopsies when initial tests yield inconclusive results. Lastly, Piliang shares a case of histoplasmosis mimicking oral ulcers, reiterating syphilis as a great mimicker in dermatology, and cautions about the immunocompromised state of patients leading to bizarre and dangerous presentations of common infections. Throughout her talk, she underscores lessons learned, such as the necessity of taking patient's travel history and remaining vigilant for less common infections in immunocompromised patients.