I have tender lesions on shins that come and go for years.
Biopsy report suggests: Granulomatous inflammation composed of well-formed epitheloid-type granulomas with surround lymphocytes, histocytes, neutrophils, and eosinophils. Perivascular and mixed inflammation with the overlying dermis. Yeast forms with focal budding within a granuloma. Mixed lobular and septal granulomatous panniculitis.
My other test results: BUN-6, total bilirubin - 1.2, Angiotensin-1 converting enzyme - 70 MID, monocytes, eosinophils, and basophils - 11, RBC - 5.26.
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I understand your concern. I have through your history and medical reports. In my opinion, the details provided fit into a condition called erythema nodosum. However, there is a possibility of deep fungal infection of skin. Erythema nodosum is a condition, wherein there occurs a reaction in the fat tissue beneath your skin. The reason for such a reaction could be many but is clearly not known. Major ones would be an infection anywhere else in the body. Intake of oral contraceptive pills or few other medications in the past, history of tuberculosis, sometimes pregnancy and so on. Symptoms occur in a repeating fashion and seen commonly in young women. You may also have fever during the episode. With treatment, the condition usually remits but recurrence depends on identification of the underlying cause and its tretment. It requires a thorough clinical and systemic examination to rule out the causes along with prescription-based immunosuppressive medications under medical monitoring.
Any bacterial infection in the body, medications taken in the past, pregnancy to name a few.Investigations to be done:
May require a tissue fungal culture to rule out a fungal pathology, chest x-ray, serum ASLO (antistreptolysin O) titer, complete blood counts, liver function tests, etc. It depends on clinical evaluation.Differential diagnosis:
Erythema nodosum, Subcutaneous mycoses.Probable diagnosis:
Erythema nodosum.Treatment plan:
May require systemic steroids and other immunosuppressive medications after confirmation of diagnosis.Preventive measures:
Avoid acute physical stress. Timely treatment of other routine illnesses have a role in preventing repeated attacks.Regarding follow up:
Would like to see a picture of the skin lesions to assess better.
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