Skip to main content

Medical Quiz - Do You Know?

This is a real Quiz and I don't have the answer.

This is a photo I took in Honduras of a woman's foot. It is resting on a wheelchair as she previously underwent a BKA (below the knee) amputation for complications of diabetes. She now had this strange, slightly ulcerated, non tender lesion on her foot for several months. You can see a smaller, less ulcerated lesion on her heel area.

I could not make a diagnosis without a biopsy. It did not appear infected, but certainly it could have been atypical TB. I also thought of necrobiosis lipoidica diabeticorum but it did not have the shiny typical features.

In Roatan there is no dermatologist nor did I have the means to do a biopsy with pathology. My final diagnosis was a pyogenic granuloma. Any ideas from you diagnosticians out there?


Unknown said…
It could be - as it looks like a pyogenic granuloma. With the pyogenic granulomas they come on really quickly and get very large, over the course of weeks to months. Every time I see a lesion that looks like that, and the history reveals such a rapid growth that I feel like I have to get the person into a Derm within a week, it is usually a PG - and I relax a bit! What did you do?
Anonymous said…
You probably already thought of these and ruled them out.
Do you think it could have been from a Brown Recluse Spider bite? Or MRSA?
Thought about Lymes from a tic bite but didn't think it looked like it.
Anonymous said…
Your differential is sound. I think I agree with pyogenic granuloma too.
Anonymous said…
What is the treatment for your diagnosis that you gave your patient?
Toni Brayer, MD said…
jason: It was Honduras. I gave her a topical antibiotic and told her to return to the clinic if it changed, grew, got red or started hurting.

anon: I ruled out spider bite and MRSA. Thanks.
About Coral know Roatan has lots of that and you get infection from that.
Anonymous said…
pyogenic granuloma, this is what my daughters primary care doc said but she did not give her any antibiotics they said to go to the dermatologist but they are scheduling for a month as they have no sooner appointments.Should i just take her to the ER it is very frigntening looking and she has been swimming and it has a weird odor to it.
Gosh, there's a great deal of useful material above!

Popular posts from this blog

scintillating scotoma

Nothing like experiencing a medical condition first-hand to really help a doctor understand it from the patient's point of view.  After all these years, I had my first (and hopefully last) scintillating scotoma while sitting on the couch playing "words with friends" on my ipad and watching TV.  A scotoma is a partial loss of vision in a normal visual field.  Scintillate is flashing, sparkles.  Put them together and you have moving, flashing sparkles with a blind spot in your eyes.

This visual aura was first described in the 19th century  by a Dr. Hubert Airy who had migraine headaches.  The visual sparks and flashes are in a zig-zag pattern and they can precede a migraine headache or occur without any pain.   The scotoma affects both eyes and closing one or the other does not make it go away.  Sometimes the term "ocular migraine" or "retinal migraine"  are used to describe this phenomenon but these involve only one eye, not both.  The terms are often …

Do Doctors Make Too Much Money?

An article in theNew York Times says the reason health care costs are so high in the United States is because doctors are paid too much. I saw that and my eyes bugged out. I just came home from a meeting with physicians and hospital administrators and the entire meeting was spent discussing the financial challenges physicians face in keeping their doors open to see patients. The goal of this meeting was to keep health services in that community so patients will have someone to care for them. Not a person in the room would agree that the doctors earn too much.

Physicians paid too much? Lets break that down. A doctor spends a minimum of 11 years in education and training after the age of 18. Many are in training for 15 or more years. They are living on student loans and contributing zero to their family's income until the residency years. At that time they earn less than minimum wage if you factor in the 80-100 hour workweek. When a doctor emerges from training (and believe me…