The Gorgas Courses in Clinical Tropical Medicine

Selected Cases Seen by 2009 Course Participants

We hope you have enjoyed the 2009 series of live cases each week from Perú.  The Gorgas Diploma Course runs annually in February and March and we will be in touch at the beginning of next year’s case series.  In addition to the 2009 cases on the Gorgas website, cases from previous years are available for full CME credit at no charge at the UAB School of Medicine's Division of Continuing Medical Education.

Eduardo Gotuzzo, M.D. and David O. Freedman, M.D.
Course Directors

History:  34 yo female admitted with a 16-month history of multiple skin lesions.  Initially, a single, painless, small (<1cm) furuncle-like lesion in the right lateral cervical area was treated with an unknown topical agent, which induced desquamation.  Pruritic lesions appearing over the next few months on her right breast were crescent-shaped and erythematous, resembling a “bite”.  Topical antifungals resulted in no improvement.  Evolution into nodular and plaque-like lesions resulted in treatment with antihistamines and intralesional steroids with some improvement.  Similar lesions subsequently appeared on chest, abdomen and limbs.

Epidemiology:  Born and lives in Lima.  Psychologist.  Unmarried.  No HIV risk factors.  No history of travel to jungle or highland areas.  No apparent TB exposures.

Physical Examination:  Afebrile.  Normal general appearance.  Chest clear.  No hepatosplenomegaly or lympadenopathy.  Normal neurological examination.  Skin [see Images A, B, C]: multiple plaques and nodules, many with a raised border and depressed center.  Some are scaly at the center; some with minimal exudation.  The lesions are painless and highly pruritic.  They are located on limbs, chest, abdomen and buttocks (where they are more confluent).  Sensation is preserved over the lesions and surrounding areas.

Laboratory Examination:  [During initial presentation 1 year earlier.]  Hb 13.5, Plt 283 000, WBC 2780, GGT 29 (normal) AST 48 (normal), ALT 43 (normal), LDH 726 (normal <300) RPR (-), Stool O & P x3 (-), all hepatitis B markers (-).  HIV (-).  Chest X-ray normal.  Abdominal CT scan normal.

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