JAMA Challenge

Question 0

Signs and pathology findings that suggests Coccidioidomycosis and not TB or lymphoma?

Answer 0

physical exam: tender, erythematous lymph nodes

Question 1

3 main presentations of Coccidioidomycosis?

Answer 1

acute primary respiratory infection (consolidation; hilar adenopathy; and pleural effusions)

chronic or residual respiratory disease (cavitations or nodules)

disseminated infection (titers > 1:16)

Question 2

Erythema ab igne caused by what chemotherapy? Histology finding?

Answer 2

Etoposide therapy

Look for starburst cells (starburst cells are postulated to represent arrest in mitosis)

Question 3

Linear IgA bullous dermatosis (vs pemphigus)?

Therapy?

Answer 3

“Jewel-like” (clustered) distribution in children

Dapsone

Question 4

Suspected Verrucous lymphatic malformation - next step?

Answer 4

US/MRI for extent

Question 5

Immunocompromised patient develops red, painless macule that evolves into hemorrhagic pustules or infarcted-appearing areas surrounded by an erythematous halo

Suspected diagnosis? Associated with?

How to distinguish from pyoderma gangrenosum or group A strep infection?

Answer 5

Ecthyma gangrenosum; Pseudomonas

Nosuppuration or sloughing of skin

Question 6

Alcoholic with history of gallstones presents with tender, erythematous to red-brown subcutaneous nodule - suspect? Next step? (if suspicions are accurate, this will show?)

Answer 6

Pancreatic panniculitis

Biopsy 
#lobular panniculitis
#subcutaneous fat necrosis with anucleate necrotic adipocytes (ghost cells)
# granular basophilic material with dystrophic calcification

Question 7

anucleate necrotic adipocytes (ghost cells) - differential?

Answer 7

#pancreatic panniculitis 
#subcutaneous mucormycosis