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September 2009
Sarah Banks, DPM, and Stephen M. Schleicher, MD
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CASE:
A 58-year-old woman seeks consultation for a lesion on her finger that developed shortly after she was stuck by the thorn of a rosebush. She initially presented 2 weeks ago, at which time ciprofloxacin therapy was begun. The lesion has not resolved, and the patient states that it bleeds spontaneously. She denies fever or malaise.
Examination of the affected area reveals an erythematous papule measuring 0.3 cm. No other lesions are noted, and axillary lymph nodes are nonpalpable.
WHAT IS YOUR DIAGNOSIS? |
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Given the history of puncture by a rosebush thorn, the working diagnosis is early sporotrichosis. Oral itraconazole is prescribed, but the patient returns after 10 days and reports that the intermittent bleeding episodes have continued. You reexamine the lesion, noting that it appears more friable. You reconsider your preliminary diagnosis and perform a shave biopsy with electrodesiccation at the base of the lesion. Fungal culture is also performed but proves negative. Histopathology reveals a pyogenic granuloma. Itraconazole is discontinued and full resolution ensues. You are reminded that minor trauma can induce a pyogenic granuloma, and you conclude that in this case the rosebush was a classic red herring.
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Dr. Banks is a podiatry/dermatology fellow in the department of podiatry at St. Luke's Hospital in Allentown, Pennsylvania. Dr. Schleicher is director of DermDOX Center in Hazleton, Pennsylvania, a clinical instructor of dermatology at the Philadelphia College of Osteopathic Medicine and Kings College in Wilkes-Barre, Pennsylvania, and an associate professor of medicine at the Commonwealth Medical School in Scranton, Pennsylvania. He is also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 41(9):29-30, 2009
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