Yours truly is busy this week, working on another writing project. This morning she got word from the Happy Hospitalist, via Google+, that a patient somewhere needs help.
…Here is a young male with a greater than 10 year history of progressive unilateral woody, nodular and odorous smelling skin changes of his calf. He has obstructive sleep apnea from significantly elevated body mass index…He has pain in his leg, which occasionally bleeds. There is no significant itching…
(For a full, disclaimed description and an instructive image, see Happy’s post.)
This story, if true, provides a good example of crowd-sourcing a diagnostic dilemma. This isn’t a “game,” played by doctors on-line who write in to say what they think is wrong in a case already solved. Rather, this is how physicians might use extant technology and free software for difficult cases, in real time, when assistance is needed.
I’ve never seen a case of Elephantiasis Nostras Verrucosa (ENV). Happy figured it out, if he’s correct, using what he describes as his medical skill set and powers of observation. (kudos!) And he used the Internet, of course, that sometimes-capitalized thing that affords access to data bases, other people’s images, dermatology atlases, and perhaps a doctor somewhere who’s seen this before.
He takes notes on the Search:
I used Google for a preliminary review of what I believed this presentation to be. Google is interesting in that if you know what keywords to use, you can find a wealth of information to help define and refine your differential diagnosis very quickly. If you don’t know what you’re searching for, it can be a black hole of worthless and dangerous information. Knowing what you’re searching for on Google is different from the lay person’s online symptom checker which leaves too much to the unhelpful imagination.
If you’re asking me, Happy, the oncologist thinks you need a biopsy to confirm almost any diagnosis. And then you (or a doctor on another shift, as your work goes, and non-anonymously) will have to send the slides, or digital images from those, to a pathologist who’s familiar with ENV.
As for the best treatment, that may take another trip to the digital stacks. (I went there.)
Some indicate an infectious component can compound chronic woody edema and lead to this picture. If that’s the case, then cultures for fungus and other kinds of organisms wouldbe appropriate, too. Next question:
In these days of cost-consciousness, can you make a diagnosis based on the leg’s appearance, without a biopsy? Maybe -
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