Abstract Body

Background and purpose

Paroxysmal hematoma of the fingers refers to a clinical picture where patients suffer sudden episodes of pain and edema of one or more fingers with subsequent appearance of predominantly hematomas in the palmar region of the proximal phalanges. It is a rare and benign process of unknown etiology. The first symptoms are severe pain, tingling and itching prior to the change in skin color. There is self-limited subdermal bleeding that disappears in the following days. The diagnosis is clinical with normal complementary tests. The main differential diagnosis is with acute ischemic processes because they have a similar presentation. Its evolution is benign and resolves without leaving sequel.

Methods and results

A 64-year-old female patient,without allergies, non-smoker, with a history of hypertension, dyslipidemia and anxiety. Current treatment, alprazolam 0.25mg/8 hours, bisoprolol 5mg/24 hours, hydrosalurethyl 50mg/24 hours, simvastatin 20mg/24 hours.

Consulting for sudden and very intense pain with subsequent appearance of hematoma in the palmar region of the fourth finger of the right hand. At the time of the examination, she had no pain with correct mobility,we observed hematoma at proximal phalanx and the middle of the fourth finger. Good distal capillary filling, radial and ulnar pulse present. Analytical non-coagulation alterations rule out autoimmune diseases. Arterial echo Doppler of the upper limb without alterations. Evolutionary control in 5 days shows process in resolution.

Conclusion

Although it´s a rare entity to see in the consultory,it´s necessary for the general practitioner to be aware of it in order to be able to advise the patient correctly and avoid unnecessary complementary studies.

Abstract Body

Background and aim

Axillary trichomycosis, also called trichobacteriosis, is a skin infection caused by bacteria of the genus Corynebacterium spp., especially by C. flavescens. It affects the hair of the armpits, also of the pubis and perianal region and, exceptionally, of the scalp.

Its prevalence is higher in tropical countries, with humid and warm climates. Excess sweating, inadequate hygiene and not shaving favor its appearance. It affects young adults, and more in men than women.

The suspected diagnosis is established by clinical findings, complementary techniques such as Wood's light, direct vision under the microscope, and dermoscopy.

Case summary

23-year-old man with no relevant history, non-smoker. Refers that for two months the armpit hair has a yellowish coloration, thicker texture and increased body odor. Denies itching, or lesions in another part of the body.

On examination, mucoid sheaths adhered to the hair shaft, thick and irregular, some covering all the hair. The root and the skin are not affected. There is a bad smell. Visualization with dermoscopy: white-yellowish masses with a waxy appearance, adhered to the hair. Rest of exploration without relevance.

Hygiene of the area, shaving and application of topical antibiotic ointment for 10 days was recommended.

Conclusion

Axillary trichomycosis is an underdiagnosed entity in primary care clinics. The general practitioner must know the use of dermoscopy since it is a useful, fast and cheap technique to support the clinical diagnosis, by identifying characteristic signs of this entity.

Abstract Body

Background and purpose

Pernicious anemia (PA), also known as Addison-Biermer disease, is a type of megaloblastic anemia caused by autoimmune gastritis or chronic atrophic gastritis type A, characterized by the destruction of the gastric mucosa, especially the fundic mucosa. The differential diagnosis includes Vitamin B12 deficiency and Celiac disease.

A 47-year-old patient who consulted for recurrent oral thrush for a year. Uninteresting personal history. First analysis: Hemogram: Hb 14.9g/dL; VCM 106 fL; VitB12 120*pg/ml; Folic 6.12 ng/mL; IgA 479 mg/dL; Anti-transglutaminase 1.5 U7mL. Physical examination: oral thrush, restless. Second analysis: Hb 10.8 g/dL, VCM 116 fL, VitB12 147.00*pg/ml.

Method and results

The case was addressed as a vitamin b12 deficiency due to diet (strict vegetarian), deciding to start treatment with oral vitamin b12 and reassess in 3 months. But the patient did not attend the consultation for a year and on his return he presented a feeling of fullness, early satiety, bloating, belching, nausea, and vomiting. Analytical control detected megaloblastic anemia. Given the high suspicion of PA, he was referred to hematology to request anti-intrinsic Facto and Anti-parietal cell antibodies. We started cyanocobalamin im. The results were positive for anti-intrinsic factor antibodies. The patient improved his symptoms while the diagnosis was confirmed.

Conclusion

PA is the most common cause of megaloblastic anemia in our surroundings. Its incidence increases with age and is rare in people under 30 years of age. Treatment with intramuscular cyanocobalamin is for life. It is related to an increase in the incidence of gastric neoplasms, and the general practitioner must search to avoid complications.

Abstract Body

Background and purpose

Congenital stationary night blindness (CSNB) belongs to a group of rare retinal genetic diseases. They are characterized by abnormal function in rods, pigment epithelium, and bipolar cells. Color vision is typically not affected by this disorder. The clinical presentation is highly variable. The presence of nyctalopia, makes us consider a wide range of diagnostic possibilities, including high-grade myopia, glaucoma, drugs, cataracts, poorly controlled diabetes, retinitis pigmentosa and keratoconus.

Methods

A 30-year-old woman with no allergies or relevant history. No smoker. Refers for the last 6 months, has had zero vision at night in the right eye, in the left eye the vision is diminished only being able to see the silhouette of the objects, during the day the patient has complete vision without any visual deficit.

Results

Primary ophthalmological examination, unexpanded fundus, a golden reflex is observed. In the ophthalmology consultation, normal biomicroscopy with normal anterior pole and in the fundus of the eye (FE) a golden reflex is observed in the entire retina without further findings at the macular or papillary level. The visual field is normal, as well as the color test. An electroretinogram (ERG) was requested and resulted in an abnormal rod scotopic and mixed scotopic response. Visual evoked potentials were normal.

The clinical history, the alteration in ERG and the appearance of the FE makes the diagnosis of CSNB suspicious. Currently, the patient is pending genetic confirmation.

Conclusions

The general practitioner must be aware of these processes that, although a minority, their suspicion can prevent a delay in the diagnosis and favor early treatment.