(BMJ)—A 22-yo man presented w/ multiple scrotal nodules that had increased in size and number over 6y. No hx of STDs, trauma, or prior surgery. Exam: multiple subcutaneous nodules. Labs: calcium, phosphate, and parathyroid hormone levels all WNL. What is the dx?
Nodular scabies
Steatocystoma multiplex
Idiopathic scrotal calcinosis
Glomangiomas
Onchocerca volvulus infection
You are correct. Based on clinical findings, the pt was diagnosed w/ idiopathic scrotal calcinosis, a rare benign condition predominantly affecting young men. The cause may be related to the dystrophic calcification of pre-existent epidermal cysts. Surgical excision is the gold standard of tx. In this pt, all nodules were excised, w/ a good clinical and cosmetic outcome.

BMJ 2018;360:k65
By vgreene, 8 March, 2018

CVVH

By vgreene, 8 March, 2018

CAVH

(BMJ)—A 65-yo man w/ hx of renal transplant 14y earlier for IgA nephropathy presented w/ L ear pain and swelling x1mo. It began as a spot in the L external canal, worsened after ear syringing, and failed to improve w/ PO or IV abx. Review of systems: negative. Exam: pinna red, hot, swollen, no pus; auricular nodes firm and tender. Labs: WNL. What is the dx?
Chondrodermatitis nodularis helicis
Relapsing polychondritis
Merkel cell carcinoma
Necrotizing otitis externa
Perichondritis
You are correct. A core bx of the palpable neck nodes confirmed Merkel cell carcinoma, an aggressive neuroendocrine tumor that can start as a painless, reddish blue papule on the skin, especially on sun-exposed areas. The risk of acquiring Merkel cell carcinoma is 24x higher in solid organ transplant recipients than in the general population. Perichondritis and necrotizing otitis externa typically respond to IV antipseudomonal abx. Regional adenopathy is not seen in relapsing polychondritis. This pt elected to have palliative radiotherapy for symptomatic control. He died 2mo after his dx.

BMJ 2017;359:j5073