[NP-Clinical] Derm

[Andy Craig]

Molluscum contagiosum??  Or flat warts?
 
Andy Craig, NP
Charlotte, NC

-----Original Message-----
From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]
On Behalf Of Lisa Meyer
Sent: Wednesday, May 16, 2007 2:49 PM
To: np-clinical at nurse.net
Subject: [NP-Clinical] Derm


Another Derm question for all...
 
I had a 20 something, very anxious, caucasion, heterosexual male yesterday
that presented to the emergency dept. initially with a complaint of a
"cold-sore in my nose".  It had been increasing over 2 weeks time.  R nasal
mucosa was tender, erythematous and had yellow crusts.  He had not had a
similar lesion before.  I told him that I though he likely had impetigo, not
a cold sore, and advised antibiotic.  He then asked me if I could do "a
bunch of labs to see if I'm alright".  Confused, I asked him what he thought
might be wrong.  At first, he says that he coughs sometimes and he's a
smoker, so he thinks maybe he has cancer.  After discussing this with him
for some time and offering him a family practice referral (he had no
primary), he blurts out that "Well what if I think I have an STD?!"   
 
Now we're getting to the issue... He noted some red spots on his penis 2
days ago.  They have not changed since he noted them.  They do not itch or
cause discomfort.  There has been no drainage or crusts.  No penile
discharge or dysuria.  Single "one-night stand" new partner sexual encounter
2 months ago.  Denies fever or chills.  Reports fatigue over the last few
months and lightheadedness off and on--"probably related to my terrible
diet".  There are 5-6 small (1-2 mm) round and oval, erythematous lesions
that are flat, some appear perhaps slightly ulcerated.  They are shiny
(almost appear moist) but dabbing with cotton tipped applicator did not
reveil drainage.  No crusts.  Non tender.  Not vesicular, and certainly did
not appear as any herpes I've ever seen before--lesions not clustered, but
diffusely scattered around the distal 1/4 of the shaft.  None on the glans.

 
Any clues?  Could they somehow be related to the impetigo I diagnosed in the
nose?  I've never seen penile impetigo and these were not crusty, but I've
got no other ideas.  
 
Lisa
 

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