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  • Skin/Oral Lesions in 20 yr old aquarium owner with cow/pig exposure

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    Old 05-10-2020, 03:21 PM   #1
    heather805
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    Unhappy Skin/Oral Lesions in 20 yr old aquarium owner with cow/pig exposure

    20-year-old female with potato peeler cut on finger, got infected 2 weeks later with low-grade fevers, slowly resolved on Bactrim over 2 weeks, then afebrile, then similar lesion on OTHER hand in another superficial wound that seemed to get infected 2 weeks after the cut. Spread to the knuckle, mild cellulitis looking, joint involved, low-grade fevers, poor response to Bactrim. Has four fish tanks, works with cows/pigs in a muddy field, gardens, has 2 cats. Now, four months later still low-grade fevers but worsening, joint nearly resolved, increasing malaise, lethargy, new skin lesions on knees, lower legs oral lesions, nasal lesion. 3 months of clarithryomycin and rifampin with increasing temps, stopped one month ago. Was on Lamictal, stopped 1 month ago with no change. Pinky finger with lesion since onset of all. What is it?

    Basic labs normal, ANA positive 1:360, 1:180. RDL antibody labs normal. ESR, CRP, procalcitonin normal. No joint pains, minimal myalgias. Now starting 2 weeks Augmentin.

     
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    Old 05-11-2020, 06:27 AM   #2
    ladybud
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    Re: Skin/Oral Lesions in 20 yr old aquarium owner with cow/pig exposure

    This sounds like an autoimmune illness, possibly lupus, which often includes all the symptoms you describe. There is also a drug induced lupus like illness that Lamictal can cause so itís good you have stopped that. A blood test for anti- histone antibodies will help differentiate drug induced lupus from the regular type. A skin biopsy with immunofluorescent studies will help in diagnosis. The second part is important as a regular skin biopsy will not do. DIL usually abates within 6 months of stopping the drug. I would not keep taking antibiotics unless you have a clear cut cellulitis in one of the skin lesions. A DS DNA test would be helpful too and you should see a rheumatologist and dermatologist.

     
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    Old 05-11-2020, 08:06 AM   #3
    heather805
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    Re: Skin/Oral Lesions in 20 yr old aquarium owner with cow/pig exposure

    Quote:
    Originally Posted by ladybud View Post
    This sounds like an autoimmune illness, possibly lupus, which often includes all the symptoms you describe. There is also a drug induced lupus like illness that Lamictal can cause so itís good you have stopped that. A blood test for anti- histone antibodies will help differentiate drug induced lupus from the regular type. A skin biopsy with immunofluorescent studies will help in diagnosis. The second part is important as a regular skin biopsy will not do. DIL usually abates within 6 months of stopping the drug. I would not keep taking antibiotics unless you have a clear cut cellulitis in one of the skin lesions. A DS DNA test would be helpful too and you should see a rheumatologist and dermatologist.
    Thank you for responding. The antibiotics have been stopped and I have seen a rheumatologist, dermatologist, and infectious disease specialist. The rheumatologist wasn't sure what it was and said to make sure it wasn't an infection so he sent us back to infectious disease who says it looks more autoimmune. No one can decide what it is so I started posting it online in hopes there are some ideas.

     
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