Print this Content

Week 23

 

Return to Image Quiz Archive

Quiz 23 Context:

A 28-year-old female presents with a complaint of persistent fevers at night for the past 3 weeks. Over the same time period she has experienced 5 pounds of weight loss in spite of little or no change in appetite. Two days prior to the visit she noticed a new painful skin rash.

Past medical history is most signficant for stage 3 chronic kidney disease thought secondary to longstanding intravenous drug abuse.

Physical examination reveals a thin female patient in no distress. Temperature is 37.8. Heart rate is 96 bpm. Blood pressure is 126/80. The cardiac examination reveals a single mid-systolic click best heard medial to the apex, followed by a soft late systolic murmur. The pulmonary examination is normal. The abdominal examination is normal. The skin and extremity examination reveals 1 + edema at the dorsum of the feet. There are several small hematomas in various stages of resolution located along the superficial veins of the upper arms. In addition there is a raised, red, somewhat tender skin lesion located on the left palm.

The new skin lesion is shown above.

This lesion, along with the history and examination, are most consistent with which of the following possibilities:

  1. Osler's node: bacterial endocarditis
  2. Gottron's papule: dermatomyositis
  3. Burrow and vesicle: scabies
  4. Bone cyst: sarcoidosis
  5. Erythema migrans: Lyme disease

 

Bookmark this Chapter
Copyright © 2000-2014 The Cleveland Clinic Foundation. All Rights Reserved.
Center for Continuing Education | 9500 Euclid Avenue, KK31, Cleveland, OH 44195
Copyright © 2000-2011 The Cleveland Clinic Foundation. All Rights Reserved.
Center for Continuing Education | 9500 Euclid Avenue, KK31, Cleveland, OH 44195