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Patient was hemoccult positive with anemia but colonoscopy and EGD were negative. What test would you order next? 

A Rare Finding of Lymphangiomatosis: Case Report 

A 5-year-old boy with a history of atopic dermatitis since 6 weeks of age, presents with a rash around his mouth that has been present for approximately 1 year. The patient’s mother reports that desonide topical cream was applied to the affected area for about 5 days, which initially resulted in improvement, however the rash returned after this medication was discontinued. The rash also recently improved after the patient took amoxicillin for an infection. She also notes that the patient has been licking his lips more frequently.

On examination there is an erythematous papulopustular eruption restricted to the perioral region, with sparing of the vermillion border. Mild hyperpigmentation is noted on the patient’s neck. There is no active involvement of other areas of the body.

The eruption has been present for 1 year and is restricted to the perioral region. What is included in your differential? 

Clinical Topics

Rash Around the Mouth of a 5-year-old Child

This 15-year-old has a pruritic, flat-topped, monomorphic papular rash on his face and arms for the past 6 days. He takes no medications, has not been sick recently, and has not been exposed to poison oak.

A.  Papular acrodermatitis of childhood (Gianotti-Crosti)

This monomorphic papular rash is unrelated to medications, recent sickness, or exposure to poison oak. It developed about 6 days earlier. 

Teen With Itchy Papular Rash on Face and Arms

A 54-year-old woman with a history of chronic pancreatitis secondary to alcohol abuse presents to your office with a chief complaint of diarrhea, weight loss, and foul-smelling, oily stools. After an appropriate workup, you diagnose her with exocrine pancreatic insufficiency and initiate pancreatic enzyme replacement therapy. She responds well to the medication and her diarrhea resolves and she begins to regain the weight she lost.

She returns 6 months later  with a complaint of return of oily stools and diarrhea, this time associated with significant bloating. She says she has strictly adhered to the enzyme replacement regimen.

A. Repeat 72-hour stool fat quantification

C. Magnetic resonance cholangiopancreatography (MRCP) 

These symptoms are recurrent despite patient's adherence to enzyme replacement therapy for pancreatitis. Your next step?

What Cause of Bloating, Oily Stool, and Diarrhea? 

A 67-year-old woman seen in clinic for unrelated concerns is incidentally noted to have a “rash” on her flank. She says it appeared in adulthood and has been stable for some years. On the right lower back, there is an asymptomatic reticulated erythema without scale or ulceration

. The patient admits to regular heating pad use on her lower back for pain. The remainder of the skin examination is within normal limits.

The patient says the incidental finding appeared in adulthood and has been stable for years. Can you identify this reticulated erythema?

An Asymptomatic Rash on the Low Back of an Older Woman 

A 66-year-old woman had a mildly pruritic rash on the buttocks, lower back, abdomen, and upper posterior thighs. The eruption had been present for approximately 18 months.

A 66-year-old woman had a mildly pruritic rash on the buttocks, lower back, abdomen, and upper posterior thighs. The eruption had been present for approximately 18 months. Your diagnosis?

“Swimsuit Area” Rash: Your Dx?

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. She has a history of multiple non-melanoma skin cancers.

Squamous cell carcinoma in situ (Bowen  disease)

Lichenoid keratosis (an inflammatory variant of seborrheic keratosis)

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. What does this look like to you?

What's This "Red Spot"?

Bruce Perlow, MD

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