Presenter of 2 Presentations
USE OF DERMOSCOPY IN THE DIAGNOSIS OF SCABIES, A USEFUL TOOL IN GENERAL PRACTICE
Abstract
Abstract Body
BACKGROUND AND PURPOSE
Scabies is an infestation by the mite Sarcoptes scabiei hominis. It is a relatively common consultation in general practice. It affects all ages and socio-economical status. Diagnosis is usually clinical, but can sometimes be difficult. In these cases, confirmation by microscope or biopsy is possible but requires an infrastructure usually not available in a primary care center. Dermoscopy can be a more accessible additional tool.
METHODS
Case presentation: A 26-year-old patient went to the primary care physician due to itching in the flexor aspects of the wrists, sides of the fingers and waist with an eruption and erythematous papules on the wrists. Based on the history and physical examination a diagnosis of scabies was made. Hygienic measures and an application of permethrin cream 5% at night two consecutive weeks were recommended to the patient and her cohabitants. After a slight improvement, the patient consulted again 15 days later due to the reappearance of the symptoms. Are we facing a recurrence of the infestation or the persistence of disease-free scabies nodules? Could it be a disease other than scabies?
RESULTS
Dermoscopy showed the mite's head inside a burrow known as a "delta wing" sign. This confirmed the presence of an active parasite within the burrows. A case of resistance was suspected and a treatment with two oral doses of ivermectin was recommended.
CONCLUSIONS
Dermoscopy can be a useful, fast and accessible diagnostic tool helpful to identify unclear scabies cases by the general practitioner.
A CASE OF VENLAFAXINE INDUCED INTERSTITIAL LUNG DISEASE
Abstract
Abstract Body
BACKGROUND AND PURPOSE
Chronic cough is a common reason for consultation in primary care, hence why family physicians need to manage its diagnosis and treatment. After considering and treating the main causes, other less common diagnosis need to be considered, requesting a chest radiograph and other tests depending on the suspected diagnosis.
Interstitial lung diseases are a heterogeneous group of pathologies that usually present themselves in the form of chronic cough and exertional dyspnoea. If suspected, a high-resolution CT scan (HRCT scan) needs to be requested by the general practitioner.
METHODS
Case presentation: A 74-year-old woman with a history of hypothyroidism and phobia treated with venlafaxine visited her family physician after 2 months of cough that had been treated without improvement, exertional dyspnoea, arthromyalgia and fever. She was sent to the emergency department, where pneumonia, Covid-19 and lung cancer were discarded in the following days. An interstitial lung disease was considered as the most likely diagnosis, with compatible images in the HRCT scan. At that time, the psychiatrist removed venlafaxine and cough improved.
RESULTS
Venlafaxine induced interstitial lung disease is a rare condition which turned to be our main diagnosis option, based on the compatible CT scan images and the clinical improvement when removing venlafaxine. This conclusion still needs to be confirmed with further studies.
CONCLUSION
A complete medical record, emphasizing in the history of exposure to toxic substances and drug-related diseases, is of utmost importance when considering the cause of chronic cough. Patients with interstitial lung diseases will benefit from an early diagnosis, which highlights the importance of early suspicion.