TWiP 188: Terrible tropisms

September 26, 2020

Dickson, Daniel and Vincent solve the case of the Baby with Hydrocephalus, and present a new clinical case for listeners to solve.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Download TWiP #188 (54 MB .mp3, 90 minutes)

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Case Study for TWiP 188

Man in 90s, suffering for months, healthy, hypertension, diabetes, large man, over 6 ft, 200 lb, rash. Full body rash for months. Gone through allergy med, cream, prednisone, some helped but regressed. Tried ivermectin 3 pills, got better for a few weeks, then rash worsened. Primary care doc did thorough exam, found abnormal area between toes, did scraping, sent to lab. When came back, asked some questions. Wife is also suffering. Gave larger dose of ivermectin, repeated 2 weeks later, wife also treated, and then recover. Not COVID-19, no HIV-AIDS, no drinking or smoking. Started before COVID, first in wife. Had gone on trip, not far away, stayed in hotel. No pets.

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Music by Ronald Jenkees

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One comment on “TWiP 188: Terrible tropisms

  1. martha krikeles Sep 28, 2020

    Dear TWIP people. I am tempted to offer my suggestion again, although I am just a retired Ob/Gyn, I have seen a fair amount of skin and rashes. I will try to be brief. Dr.Griffin has given quite a few clues and maybe a red herring. The rash is not described, is that because the description would be too telling. The wife has traveled and stayed in a hotel. Hmmm, are we supposed to wonder about bed bugs. Perhaps she traveled to visit family, such as a frail sibling in a nursing home. Certainly someone with whom she would sit for a while, holding hands and touching. It is not mentioned, but likely there was a lag between the trip and the itchy rash. An itch that is worse at night.

    The patient seemed to improve with the first course of Ivermectin, but his wife was not treated, so that improvement would not last. The good doctor who did a thorough exam and took a family history deserves a gold star. I think the description of a small crusted area that was sampled tips me in favor of scabies. ( With only a very small crusted over area, I don’t think is would be considered Norwegian scabies.)

    In addition to the Ivermectin for both people, I would also urge laundering the bedding and towels in hot water. I’m guessing the Family Doctor advised that as well.

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