Internal Medicine Resident Uses DermExpert to ID Skin Lesions

Niyati P, an internal medicine resident physician at Medical College of Wisconsin, describes how he uses VisualDx’s add-on feature DermExpert to identify challenging skin lesions:

A 38-year-old male was admitted for progressive skin lesion that started >1 month ago. Lesions are located on bilateral upper extremities. There are multiple, well-demarcated, raised, ulcerated, verrucous lesions. As an internist, identifying skin lesions is one of the biggest challenges and I love using VisualDx’s DermExpert feature to help identify the lesions. Per VisualDx analysis, the patient had cutaneous blastomycosis, which was confirmed by the biopsy done by the dermatologist!

What is blastomycosis?

Blastomycosis, also known as Gilchrist disease and North American blastomycosis, is an infection caused by the dimorphic fungus Blastomyces dermatitidis, a soil organism endemic to much of North America. Infection can involve almost any organ in the body, although the most commonly involved sites are the lungs, followed by the skin, bones, and genitourinary tract. Infection can manifest acutely as a flu-like illness or pneumonia, or with a more indolent chronic pulmonary infection. Cutaneous manifestations can include crusted verrucous or ulcerated skin lesions. These often have irregular borders and range in color from gray to violet.

What should we be aware of when making a diagnosis?

• Think of this diagnosis in patients with skin nodules or ulcers who are in the endemic regions, especially when associated with fever or pulmonary symptoms.
• Patients should be questioned if they have a pet dog that has recently been infected or sick.

How can we treat this?

Treatment recommendations from the Infectious Diseases Society of America (IDSA) include the following.

Moderately severe to severe pulmonary or disseminated disease in adult patients:

• Initial treatment with lipid formulation of amphotericin B every 24 hours or amphotericin B deoxycholate for 1-2 weeks, followed by itraconazole for 6-12 months.

See VisualDx for full treatment options.