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What's your diagnosis ?

Discussion in 'Spot Diagnosis' started by neo_star, Nov 13, 2012.

  1. neo_star

    neo_star Moderator

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    What do you suspect ?

    [​IMG]

    A case of a 5 yr old who comes in with a 3 mo history of an inflammatory mass on the scalp that had not responded to antibiotics. The chilsd is otherwise healthy.

    the arrow points to - postauricular lymphadenopathy ( and doesn't hold the clue as it is non - specific ).

    Rather than asking what's the diagnosis, i will ask ' what u suspect ? ' and how will you proceed ?
     

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  2. shubeto

    shubeto Well-Known Member

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    Kerion celsi - Griseofulvin
     

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  3. Tanya

    Tanya Well-Known Member

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    Kerion Celsi (Tinea capitis)
     

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  4. Rocket Queen

    Rocket Queen Super Moderator

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    Kerion celsi
     

  5. neo_star

    neo_star Moderator

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    Everybody wins, but the first prize goes to 'Shubeto' 4 answering it completely in 2 words.


    This is case is Picked up from the NEJM article -
    Kerion Celsi
    Laura Erin Proudfoot, M.D., and Rachael Morris-Jones, Ph.D.
    N Engl J Med 2012; 366:1142March 22, 2012DOI: 10.1056/NEJMicm1104889

    I will directly quote the article and highlight the imp points.


    A healthy 5-year-old boy presented with a 3-month history of an inflammatory mass on the scalp that had not responded to antibiotics. The physical examination revealed a boggy occipital swelling studded with pustules, as well as postauricular lymphadenopathy (arrow). The boy had no other symptoms, and the results of laboratory studies, including microbiologic swabs, were normal. A bacterial abscess was diagnosed, and he was referred for incision and drainage under general anesthesia. Before surgery, he was seen by a dermatologist who diagnosed fungal kerion, and surgery was abandoned. Subsequent scalp brushings isolated Trichophyton tonsurans. A 1-month course of oral terbinafine resulted in the successful resolution of symptoms and mycologic clearance.

    Kerion celsi is an inflammatory form of tinea capitis caused by a T-cell”“mediated hypersensitivity reaction to the causative dermatophyte. Early diagnosis may avert unnecessary and inappropriate surgical drainage.

    (-:
     

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  6. dr.angela

    dr.angela Bronze Member

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    Kerion celsi
     

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