A*******s
发帖数: 9638 | 1 响应futurehw提议， 从今天开始， 我们向大家征集平时常见的病例，所有医学科目（包括牙医学和护理学）都欢迎参加， 包括麻醉，病理。 要求： 1. Presentation； 2. Pictures。 总奖金为3000， 其中10名参与奖， 200 wb/each， 2名优秀奖， 500 wb/each， 活动到5月底结束， 或者完成12篇文章。 欢迎大家积极参加，对有价值的评论， 我们也会给予奖励。
我先开个头：
A 87 yrs old AAM presented with 1 month history of left leg pain. His
symptoms started one day after he had his prostate biopsy. It was located in his left groin area then spread to his left medial aspect of thigh. It was so painful and he had to see his doctors for the pain. It was thought he has lumbar spine problems so a MRI of lumbar spine was done. The symptoms apparently were getting worse and he has been seeing several docs. One night he really could not tolerate the pain so he went to ER. ER sent him to my clinic next day.
PMH/SH/FH/ROS were all not remarkable.
His PE were not remarkable as well.
我要求他把裤子脱下来， 他不大情愿， 但还是做了， 大家看一下照片。
我问"你的皮肤是怎么回事？" 他说是被heating pad烫伤的。
2-3 days after the pain started, he found none of meds was helpful so he
decided to use a heating pad. Next day when he woke up, he found his pain
was burning and intolerable. So he went to his PCP.
他的家庭医生和他们夫妻俩都一致认为， heating pad把他的皮肤给烫伤了， 结果他看了
两个外科医生， 按烧伤治疗了2个星期， 还用了纱布包扎， 吃了10天抗生素。 因为
疼痛扩散到会阴和直肠， 他又看了GI， 因为腿疼加重， 又看了骨科， 做了MRI。 一
个月来已经看了好多医生了。 只有两个外科医生认真看了他的腿， 给他上了药。
大家说这个老头得的是什么病？ |
c****e
发帖数: 188 | 2 looks like shingle.....am I right?
he
【在 A*******s 的大作中提到】
: 响应futurehw提议， 从今天开始， 我们向大家征集平时常见的病例，所有医学科目（包括牙医学和护理学）都欢迎参加， 包括麻醉，病理。 要求： 1. Presentation； 2. Pictures。 总奖金为3000， 其中10名参与奖， 200 wb/each， 2名优秀奖， 500 wb/each， 活动到5月底结束， 或者完成12篇文章。 欢迎大家积极参加，对有价值的评论， 我们也会给予奖励。
: 我先开个头：
: A 87 yrs old AAM presented with 1 month history of left leg pain. His
: symptoms started one day after he had his prostate biopsy. It was located in his left groin area then spread to his left medial aspect of thigh. It was so painful and he had to see his doctors for the pain. It was thought he has lumbar spine problems so a MRI of lumbar spine was done. The symptoms apparently were getting worse and he has been seeing several docs. One night he really could not tolerate the pain so he went to ER. ER sent him to my clinic next day.
: PMH/SH/FH/ROS were all not remarkable.
: His PE were not remarkable as well.
: 我要求他把裤子脱下来， 他不大情愿， 但还是做了， 大家看一下照片。
: 我问"你的皮肤是怎么回事？" 他说是被heating pad烫伤的。
: 2-3 days after the pain started, he found none of meds was helpful so he
: decided to use a heating pad. Next day when he woke up, he found his pain
|
A*******s
发帖数: 9638 | 3 You are right, so what is the final diagnosis?
【在 c****e 的大作中提到】
: looks like shingle.....am I right?
:
: he
|
c****e
发帖数: 188 | 4 neuropathy caused by shingle, or herpes zoster. Can that be the final
diagnosis?
【在 A*******s 的大作中提到】
: You are right, so what is the final diagnosis?
|
b******a
发帖数: 704 | 5 Herpes Zoster Recurrence.
Caused by Varicellar Zoster Virus. The stress (prostate biopsy) was the
trigger. More often in elderly patient (> 80?) or immunosuppressed patients
, maybe due to weak cellular immunity.
--Unilateral appearance;
--Pain, may precede onset of rash;
Is it rare the Herpes Zoster persists in sensory dorsal root of lumbar ?
Very interesting ! Thanks for the case, important for Step3 :-)
【在 A*******s 的大作中提到】
: You are right, so what is the final diagnosis?
|
r*********s
发帖数: 1027 | 6 postherpetic neuralgia
Tx with TCA?
【在 A*******s 的大作中提到】
: You are right, so what is the final diagnosis?
|
A*******s
发帖数: 9638 | 7 看来我们CMG比那几个美国医生都强啊， lol
shingle发病一个月，急性期的症状应该过去了， 后遗症疼痛可以非常严重，
postherpetic neuralgia是正确的诊断。
我觉得这么多医生看过这个病人， 居然没有一个说出正确诊断的， 这确实很悲哀。
他wife尤其对医生给他外敷药物和包扎感到不解， 前后两次， 还给抗生素。
这是一个常见病， 多发病， 任何非外科医生都可以诊断（不是歧视外科哈）。 关键
是你要亲眼看， 眼见为实， 特别是你一头雾水的时候。 Chest pain可能大多数是肋
软骨炎和GERD， 如果你多看一眼， shingle没准就是下一个诊断。 |
c****e
发帖数: 188 | 8 斑竹发包子吧. :)
【在 A*******s 的大作中提到】
: 看来我们CMG比那几个美国医生都强啊， lol
: shingle发病一个月，急性期的症状应该过去了， 后遗症疼痛可以非常严重，
: postherpetic neuralgia是正确的诊断。
: 我觉得这么多医生看过这个病人， 居然没有一个说出正确诊断的， 这确实很悲哀。
: 他wife尤其对医生给他外敷药物和包扎感到不解， 前后两次， 还给抗生素。
: 这是一个常见病， 多发病， 任何非外科医生都可以诊断（不是歧视外科哈）。 关键
: 是你要亲眼看， 眼见为实， 特别是你一头雾水的时候。 Chest pain可能大多数是肋
: 软骨炎和GERD， 如果你多看一眼， shingle没准就是下一个诊断。
|
z**********4
发帖数: 467 | |
z**********4
发帖数: 467 | |
