Derm consult?!?!?

Calciphylaxis?

 

I rotated through the derm service at Duke, and we did inpatient consults on a daily basis (usually more than one per day too!).

Although what you're describing doesn't necessarily sound classic for it, I'd consider NFD (nephrogenic fibrosing dermopathy) in any renal patient with dermatologic findings. It's a condition that was first described only within the past 10 years or so, and as a result many attendings don't even know it exists. Patients generally develop stiffness/contractures though, which it doesn't sound like your patient has. Anyway, if you get derm involved they almost always end up getting a biopsy, which is nice when it gives a definitive answer. It's pretty difficult to speculate without a picture or a better description.

http://www.emedicine.com/DERM/topic934.htm

Let us know what happens though. I'm very intrigued!

 

Having just done a derm rotation, I can tell you that inpatient derm consults are common and can be very helpful. I feel like I know a lot more derm after that rotation but those guys/gals know a ton so just call the consult. You'll probably learn something interesting by talking to them if nothing else.

 

ditto. A derm rotation is a very valuable experience going into a medicine residency. I'd very highly recommend it.

 

check that out with your derm guy. I was recently studying for Step 2 and it was one of my questions. It was such a strange question, I remembered it. But it wasn't on the real thing!

 

in my experience, some of the most interesting medicine cases have been for dermatological reasons...I had an interesting vasculitis case with isolated derm findings...also a classic dermatitis herpetiformis in celiac sprue case...I always respect the derm guys...they are all smart enough to become the best internists...I can't honestly say derm is AS challenging, but they definitely use a great deal of their faculties to diagnose conditions...anyway let us know, and thanks for the info on bullous dermatitis of dialysis and NFD (apache and gun)

 

THere is a rather long DDx for skin lesions in HD patients. I think Habif is a good derm textbook it might help you, it has a lot of images.

 

porphyria cutanea tarda is usually on sun exposed areas especially the hands, I doubt it would be on the legs.

calciphylaxis I think is typically painful, but I don't remember for sure.

Did this patient have diabetes?

 

It's an accademic point, perhaps, but you're a medical student at an accademic institution (presumably). I think it's justified by that alone....just for curiosity sake. If nothing else, it will enhance your learning, the team's learning, the learning of the consulting resident.....

Further, it could potentially affect management descisions. Is this a clue to the etiology of the patient's ESRD (i.e. does the patient have a chronic viral infection), to the patient's fever, to a med reaction, the list goes on to infinity?

If derm thinks this can be managed outpt, the consultant will let you know.

Go for it!