Fiji School of Medicine

1
Psoriasis
COW Case of the Week

• Fiji School of Medicine
• CWM Hospital.

2
Clinical History

• 51 Y Fijian Female
• Weakness, anemia fainting attacks with multiple
  raised purple skin papules.
• Known Diabetic
• High ESR(lt140), High PLT (750,000), anemia

3
Skin Lesions
4

Skin Lesions

5
Skin Lesions
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Edge of lesion
Normal

• Skin Biopsy No 61B1428A (Dt. 29-06-01)

7
Psoriasis Center of the lesion
Vesicle formation Hyper keratosis Wide Rete pegs
8
Psoriasis Center of the lesion

• Vesicle formation
• Hyper keratosis
• Wide Rete pegs

• Crusting

9
Psoriasis Micro abscess

• Vesicle formation
• Hyper keratosis
• Wide Rete pegs

• Crusting Munro micro-abscess

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Clinical notes

• The diagnosis of the skin lesions is psoriasis
• Unfortunately this does not explain the
  underlying symptoms
• An ESR greater than 100 is a sinister sign, and
  doctors who encounter such patients need to
  consider occult malignancies, severe infections
  such as endocarditis, and inflammatory conditions
  such as vasculitis, SLE, and giant cell
  arteritis.