7 INTERESTING CASES IN 2017
The most motivating, stimulating, fulfilling and sometimes guilt-stricken profession is that of a physician. It’s like drawing numbers or winning tickets from a lottery draw machine without knowing what you are going to get. Then, when you pick one, there is an overwhelming responsibility to cure that patient no matter what, and the guilt if you do not. Remember the movie City of Angels starring Meg Ryan and Nicolas Cage, where a patient of Meg Ryan died even if she tried her best to save her? Well, I had so many cases last year — the majority are okay but among the overwhelming number of patients I had a few missed cases, meaning I was not able to identify the real culprit of the problem and since they did not follow up, I missed the chance of being able to help. The reason is either because the presentation or manifestation was so different from the usual or the patient is a foreigner, whom I cannot fully comprehend — or maybe the other way around — or the patient is denying something that he should be admitting, or simply because it was really a difficult case and we have no access to the treatment that is really needed to prevent relapses or totally get a cure.
Case No. 1: AB, a 64-year-old male, was referred by another dermatologist for possible surgical removal of large nodule (bukol). When I saw the patient he was in severe pain with limited movement of his right arm. He could only lift his arm at less than 45 degrees due to the pain induced by movement. I was hesitant to do surgery, so I decided to give him an antibiotic, as I was considering a deep abscess. After seven days he was so happy with 85 percent of his symptoms gone but the inflamed area now presented with a more visible nodule (bukol). I then decided to open him up and lo and behold, out came a tablespoon of sticky pus. I extended his antibiotics and after four more days, he was completely cured.
Case No. 2: FS, a male from Indonesia who could not speak English very well, was a patient for several months. He would get better with the treatment that I gave but after a few weeks would come back with the same problem. He swore to high heaven that he followed my instructions 100 percent, but his problem kept on coming back. A biopsy did not really help this time. Then I decided to do a patch test to determine what was causing his contact dermatitis problem because he kept saying that he avoided everything I told him to avoid. Then a miracle: it was the Balsam of Peru that he had been using for a long time! He never thought that it was a type of perfume, so he continuously sprayed it all over his body.
Case No. 3: RH an elderly male who seemed to be carrying the world on his shoulders, as in the Sharon Cuneta starrer
Pasan ko ang Daigdig, was a patient for several months, too. My diagnosis was contact dermatitis. This time the patient swore on the grave of his wife that he avoided everything I told him to avoid. I believed him. But on his third followup, I felt there was really something weird about the shape and location of his rashes, so I suggested another skin biopsy. I was not surprised at the outcome because it was what I suspected from the beginning, but the patient kept denying it. Well, after pressing him he eventually admitted that he was still applying his cologne, because according to him, I only told him to avoid perfumes.
Case No. 4: LJ, a Chinese businesswoman who consulted with me about a month ago for generalized urticaria (pantalpantal) for almost three weeks. I gave her oral and topical medicines, which made it totally disappear, only to reappear after a few days. So during her follow-up I asked her several questions. She denied taking foods on the not-allowed list and said that she really steered clear of the things I told her to avoid. Then, when I mentioned alcohol, her eyes avoided mine and finally she admitted that she has a lot of business meetings that require her to drink wine and alcohol.
Case No. 5: A young Korean lady presented with red bumps on the superior area of her inter-gluteal fold (that is just above the butt crease on her back). I was wondering what it really was. Then I asked her about the course of her illness, meaning when it started, or whether she had applied anything that might have modified the rash, whether it was painful or itchy and whether she was feeling weak or with fever. In this particular case it’s not only the skin manifestations (rashes) that are important, relevant history is so vital when it comes to unusual presentation of a skin problem to end up with a more definitive diagnosis. This time it really aided me to treat this patient successfully.
Case No. 6: A 30-year-old Indian male consulted with me, saying he felt tired with a sensation of heaviness on his right forearm that extended over the shoulder. There was very little rash visible on the shoulder area and on the sides of his palm near the little finger (thenar areas in medical parlance). What I really noticed was that he was a very hairy man, especially on the forearm, and since I could not really see through the hair, I thought that it was a simple case of eczema and treated it as such. He called up the next day with blisters and severe pain along his forearm. I gave him oral antivirals plus immune boosters that improved his condition expeditiously.
Case No. 7: A two-year-old baby girl whom I diagnosed to have pyoderma gangrenosum. Treated her with a drug that improved her condition but unfortunately the second drug is no longer available in the country. But am still trying to get it from some untapped resources that hopefully can provide it and finally help this baby live a normal life.