Photo Quiz 4

52 year old female patient with CKD on Dialysis for 3 years presented with this finding.

What is it?

What is the Pathogenesis of this condition?

Answer:

HALF AND HALF NAIL

          Half and half nail (Lindsay nail) is usually diagnosed in patients with chronic renal disease. This disorder was reported first by Bean in 1963. The typical picture of half and half nail includes red, pink, or brown transverse distal bands occupying 20-60% of the total nail length with the remaining proximal portion exhibiting a dull whitish ground glass appearance.

            The estimated frequency of this change varies from 20-50% in patients with chronic renal disease. There is no correlation between the severity of renal disease and the depth of the distal color band. This disorder usually remains unchanged even after undergoing hemodialysis, but it may disappear after successful kidney transplantation.

           The pathogenesis of this condition is unknown. Stimulation of nail melanocytes by high levels of melanotrophic  hormone has been postulated and high levels of this hormone have been documented in patients with CKD in dialysis.

Photo Quiz 3

35 year old male had sustained a leg injury followed by development of a large ulcer over the accident site with high grade fever and acute renal failure.
What is the skin condition in the picture?
What is the probable organism responsible for it?



Answer:
Ecthyma Gangrenosum
       Ecthyma gangrenosum (EG) is a well-recognized but uncommon cutaneous infection most often associated with a Pseudomonas aeruginosa bacteremia. EG usually occurs in patients who are critically ill and immunocompromised and is almost always a sign of pseudomonal sepsis. The characteristic lesions of EG are hemorrhagic pustules or infracted-appearing areas with surrounding erythema that evolve into necrotic ulcers surrounded by erythema.
      This patient had grown Pseudomonas from his blood cs and he expired after 2 days of admission due to reractory septic shock.

Photo Quiz 2

8 year old male patient with h/o recurrent UTI since childhood was investigated and the following findin was documented. What is the study? What are the findings? what is the probable diagnosis?

This is a MCUG. It shows gross VUR into the left kidney with non-visualization of the right kidney. The Urinary baldder shows trabeculations due to the chronic obstruction and the posterior urethra is dilated. The DTPA scan showed two kidney with grossly reduced GFR. Cystoscopy was done which showed PUV. The child has already developed severe growth retardation and CKD

Photo Quiz 1

50 year old female with h/o Raynaud's phenomenon, dysphagia and exertional dyspnea presented with this finding. What is the finding? and what is the diagnosis?

ANSWER: Case of systemic sclerosis with calcinosis cutis