Asymptomatic crusted lesions on the palms
Was there a link between where the patient lived (a nursing home) and the lesions on her hands?
AN 86-YEAR-OLD WOMAN with a high-grade fever for several days was brought in to our emergency department (ED) for evaluation. The patient lived in a nursing home and was in a persistent vegetative state. She had been bedridden for several years and had a history of stroke and dementia.
While examining the patient, we noticed multiple scattered erythematous keratotic papules and plaques on her face, trunk, and limbs. There were also yellow to brownish compact, thick, scaly, crusted plaques on both of the patient’s hands (FIGURE). We gathered skin scrapings from her palms and sent them to the lab. We also ordered lab work including a complete blood count, urine biochemistry, and a urine culture.
FIGURE
Thick, brownish hyperkeratotic plaques on the palm
WHAT IS YOUR DIAGNOSIS?HOW WOULD YOU TREAT THIS PATIENT?
