Sheeza Basharat
Sheeza Basharat5 months ago
Diagnose It

Diagnose It

A 75-year-old man sought care from his primary care physician because his “fingernails and toenails [were] all falling off.” He did not feel ill and had no other complaints. His vital signs were unremarkable. He had no history of malignancies, chronic skin conditions, or systemic diseases. His fingernails and toenails were discolored and lifting from the proximal end of his nail beds (FIGURE). One of his great toenails had already fallen off, 1 thumb nail was minimally attached with the cuticle, and the rest of his nails were loose and in the process of separating from their nail beds. There was no nail pitting, rash, or joint swelling and tenderness.⁠ ⁠ The patient reported that while on vacation in Hawaii 3 weeks earlier, he had sought care at an urgent care clinic for a painless rash on his hands and the soles of his feet. At that time, he did not feel ill or have mouth ulcers, penile discharge, or arthralgia. There had been no recent changes to his prescription medications, which included finasteride, terazosin, omeprazole, and an albuterol inhaler. He denied taking over-the-counter medications or supplements.⁠ ⁠ The physical exam at the urgent care had revealed multiple blotchy, dark, 0.5- to 1-cm nonpruritic lesions that were desquamating. No oral lesions were seen. He had been given a diagnosis of hand-foot-mouth disease (HFMD) and reassured that it would resolve on its own in about 10 days.⁠ ⁠ What's the diagnosis?

Top rated comment
5 months ago

did he step on some kind of urchin?

5 months ago

Or jellyfish

Other commentsSign in to post comments. You don't have an account? Sign up now!
4 months ago

If he had that, wouldn't have his joint areas have a rash and inflammation? Did he go into the ocean and then get symptoms? Did he only swim in pool?

Recent MCQs

Show more MCQs

Recent flashcard sets

Show more flashcards