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Home » Lewy body disease

Consultant. Vol. 49 No. 8
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What’s Your Diagnosis?
Sharpen Your Physical Diagnostic Skills 

An Aged Man With One Big Chest Lesion and a Scattering of Smaller Ones

By HENRY SCHNEIDERMAN, MD—Series Editor—and ALEXANDER MBEWE, MD | August 3, 2009
The authors are with Hebrew Health Care, West Hartford, Conn. Dr Schneiderman is vice-president for medical services and physician-in-chief, and Dr Mbewe is staff physician. Dr Schneiderman is also professor of medicine (geriatrics) and associate professor of pathology, University of Connecticut Health Center in Farmington, and clinical professor, nursing, Yale University.

This article was originally presented as an independent educational activity under the direction of CME LLC. The ability to receive CME credits has expired. The article is now presented here for your reference. CME LLC is no longer respoinsible for the presentation of the article.

HISTORY 

A 78-year-old man is seen upon admission to a behavioral hospital unit. Agitation and visual hallucinations led to this admission. A similar prior episode, complicating his established Lewy body dementia, cleared with hospitalization and clozapine(Drug information on clozapine) therapy.

PHYSICAL EXAMINATION

Mildly obese man who is conversationally capable and friendly, though dementia is also evident. Vital signs normal. Has a large central sternal seborrheic keratosis. Skin about right breast as shown. Murmur consistent with aortic stenosis. Ventral hernia.

What’s Your Diagnosis?

(answer on next page)

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by robert caudill | April 27, 2010 12:24 PM EDT

Two dermatologic events are going on. First there is a large verrucous lesion on sternal area which could represent a non pigmented seborrheic keratosis vs viral verrucous wart(HPV). Excisional biopsy should settle the issue. The smooth abdominal lesions are likely polythelia as mentioned. rgc






 
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