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, 43 patients showed self-induced dermatological lesions ( 2 ). They were generalized or localized especially into the breast, face, legs, or genitalia. These pathomimic lesions are generally characterized by constant picking of the skin, leading to
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Department of Dermatology, Mohammed VI Hospital, Faculty of Medicine and Pharmacy, Mohamed Ist University, Oujda, Morocco
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Laboratory of Epidemiology, Clinical Research and Public Health
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. Calcinosis cutis occurring in association with autoimmune connective tissue disease: the Mayo Clinic experience with 78 patients, 1996–2009 . Archives of Dermatology 2012 148 455 – 462 . ( https://doi.org/10.1001/archdermatol.2011.2052 ) 10.1001/archdermatol
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treatment is indicated, since there is no cure for MSD. In our case, we referred our patient to a dermatologist due to dermatologic symptoms (ichthyosis) to treat her by applying one of the many skin softeners available in the market. In our experience
Department of Diabetes and Endocrinology, Wakayama Red Cross Hospital, Wakayama, Japan
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Tokura Y Yagi H Yanaguchi H Majima Y Kasuya A Ito T Maekawa M & Hashizume H 2014 IgG4-related skin disease . British Journal of Dermatology 171 959 – 967 . ( doi:10.1111/bjd.13296
Neuro-Ophthalmology of Texas, and Neuro-Eye Clinical Trials Inc., Houston, Texas, USA
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438 – 446 . ( https://doi.org/10.1210/jcem.87.2.8220 ) 2 Fatourechi V Pretibial myxedema: pathophysiology and treatment options . American Journal of Clinical Dermatology 2005 6 295 – 309 . ( https://doi.org/10.2165/00128071-200506050-00003 ) 10
Cancer Diagnosis and Pathology Group, Kolling Institute, Sydney, New South Wales, Australia
Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Cancer Diagnosis and Pathology Group, Kolling Institute, Sydney, New South Wales, Australia
Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
Department of Diabetes and Endocrinology, Nepean Hospital, Kingswood, New South Wales, Australia
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Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Cancer Diagnosis and Pathology Group, Kolling Institute, Sydney, New South Wales, Australia
Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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is currently stable ( Fig. 3 ). Diabetes remains well-controlled, with no evidence of macrovascular or microvascular disease. Dermatology Life Quality Index (DLQI) score is 10/30, indicating moderate effect on quality of life (QoL) mostly due to
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University of Melbourne, Parkville, Victoria, Australia
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-Candiani J González-González JG Gómez-Flores M . Skin manifestations of insulin resistance: from a biochemical stance to a clinical diagnosis and management . Dermatology and Therapy 2017 7 37 – 51 . ( https://doi.org/10.1007/s13555-016-0160-3 ) 10
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School of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
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Summary
Diabetes mellitus is a well-recognised risk factor for melioidosis, the disease caused by Burkholderia pseudomallei, which is endemic in northern Australia and Southeast Asia. We present the initial diagnostic dilemma of a febrile patient from northern Australia with type 1 diabetes mellitus and negative blood cultures. After a 6-week history of fevers and undifferentiated abdominal pain, MRI of her spine revealed a psoas abscess. She underwent drainage of the abscess which cultured B. pseudomallei. She completed 6 weeks of intravenous (IV) ceftazidime and oral trimethoprim/sulphamethoxazole (TMP/SMX) followed by a 12-week course of oral TMP/SMX. We postulate that the likely route of infection was inoculation via her skin, the integrity of which was compromised from her insulin pump insertion sites and an underlying dermatological condition.
Learning points:
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Diabetes mellitus is the strongest risk factor for developing melioidosis.
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Atypical infections need to be considered in individuals with diabetes mellitus who are febrile, even if blood cultures are negative.
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There is heterogeneity in the clinical presentation of melioidosis due to variable organ involvement.
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Consider melioidosis in febrile patients who have travelled to northern Australia, Asia and other endemic areas.
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156 205 – 210 . ( doi:10.1111/j.1365-2249.2009.03895.x ) Smith YR & Haefner HK 2004 Vulvar lichen sclerosus: pathophysiology and treatment . American Journal of Clinical Dermatology 5 105 – 125 . ( doi:10
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intratesticular testosterone production and is thus directly harmful to fertility prospects. Case presentation A 32-year-old man with congenital ichthyosis managed in our hospital’s Dermatology Department was referred to our endocrinology department for