CASE 72
A 58-year-old man presented with a 3-week history of progressive, mildly painful skin lesions on his left arm that had begun with an erythematous lesion on his left thumb. A reddish streak was apparent along these lesions. The patient did not have any fevers or chills.
He enjoyed working in his garden but he did not recall any specific injury.
PHYSICAL EXAMINATION
LABORATORY STUDIES
Diagnostic Work-Up
Table 72-1 lists the likely causes of illness (differential diagnosis). A clinical diagnosis of a subcutaneous infection was considered. Investigational approach may include
TABLE 72-1 Differential Diagnosis and Rationale for Inclusion (consideration)
Rationale: There are few organisms that manifest with such lesions in a subacute manner. Sporothrix schenckii is the most common cause, followed by Nocardia and atypical mycobacterial infections. Some of the other infections, notably cat-scratch disease and tularemia, usually produce significant systemic symptoms and have appropriate exposure histories. Pyogenic infections (e.g., S. pyogenes, S. aureus) present more acutely and perhaps with systemic symptoms. AIDS patients may have lesions due to Kaposi sarcoma or bacillary angiomatosis that manifest indolently as well.
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