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- Presentation
Inpatient Dermatology: From Horses to Zebras
Description
In this presentation, Dr. Zach Schwager, Director of Inpatient Dermatology at the Leahy Clinic, discusses the unique challenges of diagnosing dermatologic conditions in hospitalized patients. He emphasizes the concept of 'horses in disguise,' highlighting how common conditions can present atypically in immunocompromised patients. He presents several cases, starting with a liver transplant patient with a bizarre leg lesion initially suspected to be blastomycosis, which later turned out to be an invasive dermatophyte, Trichophyton rubrum. The importance of considering atypical presentations of known pathogens is reaffirmed. He then shares a case of herpes simplex virus type 1 presenting as a verrucous plaque instead of the typical vesicular rash. The third case involves a patient with chronic inflammatory skin conditions, ultimately diagnosed as pyoderma gangrenosum-acne-hidradenitis suppurativa (PASH), a rare autoimmune inflammatory syndrome. Dr. Schwager concludes by urging healthcare professionals to be vigilant for both uncommon diseases and unusual presentations of common conditions in inpatient settings, reminding them to always consider if the diagnosis might be a 'horse in disguise.'
View moreConclusions
- Common dermatological diseases can present atypically in inpatient settings due to altered patient conditions such as immunosuppression.
- Invasive Trichophyton rubrum can mimic blastomycosis in immunocompromised patients, leading to misdiagnosis without thorough investigation.
- Histopathological findings may suggest invasive fungal infections, but microbiology cultures could yield misleading results.
- Atypical presentations of viral infections, like herpes simplex virus, can resemble malignancies in immunosuppressed individuals.
- Understanding the variability in dermatologic presentations can improve diagnostic accuracy in inpatient dermatology.
- Collaborative diagnostics involving clinical evaluation, histopathology, and microbiological cultures are essential for accurate diagnosis and treatment.
- Treatment strategies may vary significantly based on the correct identification of the underlying condition, highlighting the importance of precise diagnosis.
- Inpatient dermatology requires a heightened awareness of atypical disease presentations to avoid diagnostic pitfalls.
- The need for comprehensive care, including genetics and immunology considerations, is critical in managing complex dermatological conditions.
- Marc Grossman, MD, FACPa; Faezeh Talebi-Liasi; Michi M. Shinohara, Dysmorphic Trichophyton rubrum Mimicking Blastomycosis in a Patient with Solid Organ Transplant.
- Adriano Piris, MD; Punch Biopsy Results: Atypical verrucous and endophytic squamous proliferation with exuberant acute and chronic inflammation, 9/26/2023.