Guess What -ans

Potential Diagnostic Clue- 

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Deepika Bhardawaj

Image 1: Uremic frost.

Uremic frost was described by Hirschsprung in 1865.It is seen in end-stage renal disease. It consists of a white or yellowish coating of urea crystals and involves the face, neck, and trunk [1, 2]. These are friable and crystalline. Differential diagnosis of uremic frost includes- Retention keratosis, Eczema, Post-inflammatory desquamation.

References

  1. Kuo CC, Hung JB, Tsai CW, Chen YM. Uremic frost. CMAJ. 2010 Nov 23;182(17): E800.
  2. Udayakumar P, Balasubramanian S, Ramalingam KS. Cutaneous manifestations in patients with chronic renal failure on hemodialysis. Indian J Dermatol Venereol Leprol. 2006; 72:119–125.

 

Image 2: Janeway lesions

 Janeway lesions are pathognomonic of infective endocarditis. These are rare, non-tender, and a few millimeters in size [1]. Lesions are erythematous or hemorrhagic macular, papular or nodular on the palms or soles [1]. Differential diagnoses of Janeway lesions are Coxsackievirus, Cutaneous vasculitis, Disseminated Intravascular Coagulation (DIC), Meningococcemia, Thrombotic thrombocytopenic purpura, etc. 

References

    1. Gunson TH, Oliver GF. Osler’s nodes and Janeway lesions. Australasian journal of dermatology. 2007 Nov;48(4):251-5.
    2. Sailer C, Wasner S. Differential Diagnosis Pocket: Clinical Reference Guide. Borm Bruckmeier Publishing LLC; 2002 Oct.

 

Image 3. Gouty tophus.

Gout is an inflammatory arthritis characterized by recurrent attacks of a red, hot, tender, and swollen joint [1][2]. A tophus is a deposit of monosodium urate crystals and is pathognomonic for the disease gout. Tophi form in the joints, cartilage, bones, and other sites, most commonly involving the first metatarsophalangeal joint. Differential diagnosis of gout includes Trauma, Rheumatoid arthritis, Septic arthritis, Pseudogout.

References

  1. Dalbeth, N; Merriman, TR; Stamp, LK (April 2016). “Gout”. Lancet (Review). 388 (10055): 2039–2052.
  2. Hui M, Carr A, Cameron S, Davenport G, Doherty M, Forrester H, Jenkins W, Jordan KM, Mallen CD, McDonald TM, Nuki G. The British Society for Rheumatology guideline for the management of gout. Rheumatology. 2017 Jul 1;56(7): e1-20.

 

Image 4: Carpopedal spasm

Carpopedal Spasms are frequent and involuntary muscle contractions in the hands and feet with associated pain. Carpopedal spasms can be a warning sign of Hypocalcemia [1]. Causes of Hypocalcaemia include Nutritional, Vitamin D / PTH hormone deficiency Metabolic alkalosis [2], Renal losses of Calcium.

References

  1. Fong J, Khan A. Hypocalcemia: updates in diagnosis and management for primary care. Canadian family physician. 2012 Feb 1;58(2):158-62.
  2. Richardson RM, Forbath N, Karanicolas S. Hypokalemic metabolic alkalosis caused by surreptitious vomiting: report of four cases. Canadian Medical Association Journal. 1983 Jul 7;129(2):142.

 

 

Image 5: Dry gangrene

 

Dry gangrene is a form of coagulative necrosis which is the result of chronic ischemia without infection. The feet and hands are most commonly affected. Limb becomes dry, shrunken, and dark reddish black. Dry gangrene is a harbinger of other diseases [1], which often includes peripheral artery disease. Risk factors [2] include: Arteriosclerosis, Cardiovascular disease, Dyslipidemia, BMI more than 30 kg/m2, HTN, DM, Tobacco use, HIV, Elevated homocysteine levels.

References

  1. Smith, Tyler (2015). Gangrene Management: Today and Tomorrow. Hayle Medical.
  2. Krishna SM, Moxon JV, Golledge J. A review of the pathophysiology and potential biomarkers for peripheral artery disease. International journal of molecular sciences. 2015 May 18;16(5):11294-322.