babli
Forum Guru
Topics: 40
Posts: 425
|
A 62-year-old man presents to the emergency room with pain and swelling in his left foot, which also has patches of discoloration that have been present for three months. The pain and swelling, however, have appeared only during the previous week. His medical history is significant for rheumatoid arthritis and hypertension, and his current medications include fosinopril and atenolol. He also started cephalexin therapy three days before this visit, as prescribed by his primary care physician. Physical examination reveals a slightly swollen and tender foot marked by purplish blotches and a nontender discolored plaque on the sole.
What is your diagnosis?
Attached Files:
Dec01DxG.jpg (13 KB, 12 downloads)
|
| Jinx
Forum Elite
Topics: 17
Posts: 316
|
Kaposis Sarcoma???---wild guess here just based on lesion--esp with nothing suggesting HIV
___________________
Life is a journey--enjoy the drive!!
|
| msyamp
Forum Fanatic
Topics: 60
Posts: 1,462
|
vasculitis leading to purpurae and gangrene
___________________
If you think you can You can! If you think you cant you are right again!!
|
| Banti
Forum Newbie
Topics: 0
Posts: 23
|
hello babli, banti here. it is kaposi as it looks. it canbe vasculitis too as msyamp said. what do you say?
|
| cyra
Moderator
Topics: 29
Posts: 844
|
I am thinking of bacillary angiomatosis which can have a presentation similar to kaposi's sarcoma.
|
| aml
Forum Senior
Topics: 5
Posts: 129
|
KAPOSI SARCOMA IS MOST LIKELY. CONFIRM BY BIOPSY & RULE OUT AIDS IN THIS PATIENT.
|
| babli
Forum Guru
Topics: 40
Posts: 425
|
http://www.emedmag.com/html/pre/dia/12_01.asp
|
| guayoman
Forum Elite
Topics: 44
Posts: 273
|
Great page babli.
___________________
Confidence does not come from simply reading the content, but from doing things with it. Confidence is born in the flash of insight, in the ability to face something new and figure it out.
Kaplan usmle edge newsletter
|
| AAAAA
Forum Fanatic
Topics: 156
Posts: 1,991
|
Treatment of Kaposi's sarcoma depends on the extent of the disease, the rate of progression, and the presence and severity of symptoms affecting daily activities and quality of life. The choice of treatment may also be influenced by the severity of the underlying HIV infection and by the presence of any other complications.
Management of Kaposi's sarcoma includes antiretroviral therapy for the patient's particular stage of HIV infection, along with preventive measures against opportunistic infections and prompt treatment of any infections that occur.
Treatments that reduce levels of HIV and relieve AIDS symptoms such as immune system suppression may also alleviate Kaposi's sarcoma lesions. Researchers are not sure whether this is because improved immune function allows the body to control HHV-8 (the virus associated with Kaposi's sarcoma) more effectively, or because control of HIV reduces the levels of certain body proteins that stimulate the growth of Kaposi's sarcoma lesions.
Local Therapies
Cryotherapy
Cryotherapy involves freezing the lesion with liquid nitrogen, which causes the lesion to blister, scab, and eventually slough off. This treatment usually leaves minimal marks on light-skinned people, although it often causes loss of pigmentation (white spots) on those with darker skin. Laser surgery is also sometimes used to treat Kaposi's sarcoma lesions.
Radiation Therapy
Radiation therapy may be used to treat Kaposi's sarcoma, particularly when the lesions are large and bulky or cause pain. It is used more commonly to treat Kaposi's sarcoma of the skin and oral cavity than it is to treat Kaposi's sarcoma of the internal organs.
Local Chemotherapy
Some doctors may treat lesions with injections of an anti-cancer drug such as vinblastine, in a treatment called intralesional chemotherapy. A gel containing alitretinoin (a derivative of vitamin A) was approved by the FDA in 1999 for topical application on Kaposi's sarcoma lesions.
Systemic Chemotherapy & Biologic Therapy
In some cases, particularly when lesions are extensive on the skin or involve internal organs or cause lymphedema, doctors may administer anti-cancer drugs intravenously. The most commonly used drugs are liposomal doxorubicin, liposomal daunorubicin, and paclitaxel.
One approach physicians at Memorial Sloan-Kettering pioneered involves the use of interferon-alpha. This drug inhibits some of the growth factors associated with Kaposi's sarcoma, and it inhibits HIV as well. Responses to interferon-alpha can occur slowly, however, and patients must adhere to a regimen of frequent self-injections. Physicians at Memorial Sloan-Kettering are researching how best to use interferon alpha in combination with other drugs used to treat Kaposi's sarcoma.
Because the formation of new blood vessels (angiogenesis) plays an important role in the growth of many cancers including Kaposi's sarcoma, researchers are studying natural and synthetic angiogenesis inhibitors in the treatment of AIDS-associated Kaposi's sarcoma. Therapy using nose drops containing the angiogenesis inhibitor IM862 has shown success for patients in early clinical studies, and is currently being evaluated in multi-center trials. In addition to inhibiting production of angiogenesis growth factors VEGF (vascular endothelial growth factor) and bFGF (basic fibroblast growth factor), this naturally occurring protein also increases production of interleukin-12, which has been shown to enhance immune function.
Thalidomide, which was approved by the Food and Drug Administration in 1998 for use in patients with leprosy, is another angiogenesis inhibitor being studied in Kaposi's sarcoma.
------------------------------------------------------------------------- -------
___________________
seeking study partner in USMLE, Canadian MCC OSCE examination
|
| AAAAA
Forum Fanatic
Topics: 156
Posts: 1,991
|
I saw some KS among homosexual HIV patients in the 1980's but I don't see KS in 2006 now. i wonder why the incidence dropped so much !
it is because of the effectiveness of the anti-HIV virus therapy !
___________________
seeking study partner in USMLE, Canadian MCC OSCE examination
|
| AAAAA
Forum Fanatic
Topics: 156
Posts: 1,991
|
I saw this in an airline attendant from Atlanta in 1985. He died 30 days later during a protracted illness ! OMG
Attached Files:
kaposi.gif (91 KB, 0 downloads)
___________________
seeking study partner in USMLE, Canadian MCC OSCE examination
|
| AAAAA
Forum Fanatic
Topics: 156
Posts: 1,991
|
interferon is the drug of choice for metastatic KS
___________________
seeking study partner in USMLE, Canadian MCC OSCE examination
|
| AAAAA
Forum Fanatic
Topics: 156
Posts: 1,991
|
Homosexual HIV patients have more plagues like KS than the one you presented
___________________
seeking study partner in USMLE, Canadian MCC OSCE examination
|
|
| |
| | | | | | | | | | | | | |
