S068 - Skinternal Medicine: An Update on Cutaneous Manifestations of Systemic Disease

Leslie Stroud, chair of dermatology at Wake Forest, presents a challenging case of a middle-aged male patient with a long-standing, non-healing ulcer on his right leg. The patient, previously healthy but with a history of hereditary osteochondromas, was transferred to their hospital after not receiving adequate care at an outside facility lacking dermatology. Upon arrival, he exhibited signs of severe illness, including anemia and possibly sepsis, and had undergone multiple consultations, but no effective treatment had been provided earlier. His extensive ulceration raised concerns about potential malignancy or infection, and although initial cultures grew Serratia and Proteus, further investigation revealed a rare case of invasive candidiasis. Diagnostic biopsies showed inflammatory changes, but fungal elements were confirmed through special staining. The patient was started on fluconazole, recommended for a prolonged course due to his condition. Surgical interventions were necessary, including the excision of osteochondromas, along with ongoing collaboration with infectious disease specialists. This case highlights the complexities of diagnosing and treating opportunistic infections in immunocompetent patients and underscores the value of multidisciplinary teamwork in managing such rare conditions.