What do these presentations add up to? By Dr Keith Hopcroft
CASE EASY
The patient
A 28-year-old female who smokes and has a history of mild obesity.
She says
‘I’ve got my infection back again. This is the third time in the last year that it’s flared up. And even after I’ve taken the antibiotics I’m left with lumps in my armpits. I’m starting to get it in my groin too.’
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CASE MODERATE
The patient
A 32-year-old man with a history of ulcerative colitis, for which he takes oral mesalazine.
He says
‘My eye’s been uncomfortable and red for a few days. I was given chloramphenicol drops by the pharmacist but they haven’t helped. My vision’s okay and the eye’s not sticky. It’s really only a bit sore and red on one side.’
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CASE HARD
The patient
A 15-year-old girl with no previous problems and on no medication.
Her mother says
‘My daughter has got this lump in her neck. It’s been there for months and moves when she swallows. One doctor said it was a gland and would go and another gave her antibiotics, which didn’t
help much.’
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Dr Keith Hopcroft is Pulse’s medical adviser and a GP in Basildon, Essex
Answers
EASY Hidradenitis suppurativa This is a chronic inflammatory skin condition typically affecting the axillae and groin. It results in nodules, sinuses, discharge and scarring, with painful exacerbations. Initially it may be viewed as a one-off folliculitis or abscess – the recurrence, spread to other areas and chronic changes indicate the diagnosis. Treatment involves lifestyle changes – there is an association with obesity and smoking – and, usually, long-term oral antibiotics.
MODERATE Episcleritis This characteristically causes a segmental patch of redness in the eye with mild soreness or irritation, but no visual impairment. It resolves spontaneously within a week or so, and any troublesome symptoms can be treated with topical or oral anti-inflammatories. In most cases the cause is unknown, but it can occasionally be associated with underlying disease such as inflammatory arthritis or inflammatory bowel disease.
HARD Thyroglossal cyst These cysts are a congenital abnormality though they may not present until childhood or later. They typically move with swallowing and also on tongue protrusion. They can become infected, in which case antibiotics will ease the inflammation but not resolve the underlying problem. They can be left alone but can be excised if troublesome.
Please note – these are all fictional cases and not based on any real patient interactions
