INTERNAL MEDICINEStories From the Field

Unusual Rash Leads to Sarcoidosis Diagnosis

I recently saw a young, healthy African American man who was concerned about a rash that began on his posterior neck and later spread to his extremities, genitals, and face. He had previously seen a dermatologist who biopsied a lesion, but the results were inconclusive, and he was given a steroid cream. The distribution and appearance of the lesions were unusual, so I entered his information into VisualDx. The differential diagnosis list generated by the app suggested sarcoidosis as a possibility. I ordered additional labs and chest imaging, which quickly confirmed the diagnosis. The patient was relieved to finally have a diagnosis and a plan for treatment.

—P.L., University of Pennsylvania physician

Resident Uses VisualDx to Compare Potential Diagnoses and Therapy Options

As an internal medicine resident, I frequently encounter a range of dermatological presentations, from common cosmetic concerns to more serious pathological conditions. VisualDx is invaluable in helping me differentiate between the two, but it’s equally useful for other common outpatient issues.

I recall one notable case of a patient with persistent facial redness and pustules. VisualDx assisted me in diagnosing rosacea and helped me compare it to other differential diagnoses. Initially, I considered treating with sodium sulfacetamide alone, but VisualDx highlighted the benefits of adding oral doxycycline to the treatment plan. This combination approach led to significant improvement in the patient’s condition. VisualDx not only enhanced my diagnostic accuracy but also expanded my therapeutic options. Plus, it’s as fast as an experienced attending when it comes to patient care!

—P.A., Emory University School of Medicine resident

Internal Medicine Physician Makes a Crucial Diagnosis

A patient presented with diffuse ulcerative/herpetic mouth lesions, massive hepatomegaly, and significant new-onset shortness of breath. Blood work was completed, and VisualDx helped me diagnose leukemia. The patient is now undergoing critical treatment. The app was very easy to use. Thank you.

—C.R., University of Massachusetts physician

Physician Confirms Toxic Shock Syndrome After Overdose

A patient presented with loss of consciousness following an overdose on hard drugs, along with skin lesions, persistent hypotension, and fever. My suspicion of toxic shock syndrome (TSS) was confirmed using VisualDx. The blood culture results further supported the diagnosis.

—F.B., University at Buffalo physician

Physician not Stumped by an Atypical Presentation

I used VisualDx to help diagnose shingles in an elderly woman of color who had severe dementia and was unable to clearly communicate what was wrong. She repeatedly pointed to her side, so we conducted a thorough skin examination and noticed an atypical dermatomal rash with some vesicles. The rash didn’t have the classic ‘dew drops on a rose petal’ appearance due to her darker skin tone. VisualDx helped narrow down the differential diagnosis, leading us to the correct conclusion. Her rash resolved with the appropriate treatment for shingles.

—M.P., University of Florida College of Medicine physician

Patient Reassured by Images and Information

An African American female presented to our clinic with concerns for cancer after finding a dark line on her fingernail. After comparing melanoma and longitudinal melanonychia images and clinical content and asking more relevant questions, I was able to alleviate my patient’s concern for cancer and convince her of her diagnosis.

—M.L., Emory School of Medicine physician

VisualDx Improves APP’s Decision-Making and Confidence

Throughout medical school and internal medicine residency, I received limited dermatological training. The use of VisualDx has significantly improved my diagnostic and therapeutic decision-making. One example that stands out is when a young female came to my continuity clinic with a smooth, annular raised lesion. I would have struggled to identify it on my own, but with VisualDx’s search engine, I confidently diagnosed it as granuloma annulare. Now, I’ll never forget it!

—M.L., Emory School of Medicine physician assistant

Beyond Dermatology: VisualDx Covers Drug Reactions and More 

I was treating a cardiology patient with complaints of syncope, which has a fairly long differential. Our team couldn’t identify a cause, and no medications stood out as potential triggers. The patient was on an older antiarrhythmic medication, which we believed should reduce syncopal episodes if the patient was in normal sinus rhythm. However, when using the VisualDx app, we discovered that this medication is known to interact with another of the patient’s medications and cause syncope. Thanks to VisualDx, we identified the issue, leading to a great outcome for the patient.

—L.C., medical student