Photos, facts and fibs... four morbiliform rashes
Vol.17, No.10, December 2009

This quiz is just for fun. Test your diagnostic skills with the dermatological photos, then separate truth from fiction in the statements about Sjögren’s syndrome and hemochromatosis. Any of the statements below might be true… and any might be pulling your leg. Answers are below.

1. These four morbiliform (measles-like) rashes are almost indistinguishable, but each is caused by a different condition. The four conditions are listed below, along with two that wouldn’t cause such rashes. Which two are the odd men out?

a) Rubella (German measles)

b) Rubeola (measles)

c) Erythroderma

d) Amoxicillin reaction

e) Toxic shock syndrome

f) Ichthyosis vulgaris

2. These photos show the following dermatological conditions: miliaria rubra, miliaria crystallina, Grover’s disease, molluscum contagiosum, pemphigus foliaceus. Match the photo to the condition.

3. Fact or fib — which of these statements are true, and which are false?

Sjögren’s syndrome:

a) is three times more common in women than in men

b) only affects adults, especially the over-50s

c) increases the risk of Hodgkin’s lymphoma

d) necessitates frequent dental visits to prevent tooth decay

e) can be diagnosed by the presence of anti-Ro and anti-La antibodies

Hereditary hemochromatosis:

a) is an autosomal recessive disorder for which 1 in 9 Canadians is a carrier

b) only afflicts people of Northern European descent

c) may be diagnosed by high serum ferritin

d) is the second most common inherited disorder in the Western world

e) can shorten the lives of sufferers and their first-degree relatives

ANSWER

1. The odd ones out are erythroderma and ichthyosis vulgaris, neither of which cause morbiliform rashes. The pictures are: (a) toxic shock syndrome morbiliform rash; (b) amoxicillin reaction rash; (c) German measles; (d) measles, third day rash

2. The pictures are: (a) Miliaria rubra; (b) Pemphigus foliaceus; (c) Miliaria crystallina; (d) Grover’s disease; (e) Molluscum contagiosum

3. Sjögren’s syndrome: (a) False, it’s 8-9 times more common in women than in men; (b) False, Sjogren’s can affect children, and peak ages are 30-60; (c) False, it increases the risk of non-Hodgkin’s B–cell lymphoma; (d) True; e) False, about 85% of patients have anti-Ro and about 50% have anti-La antibodies. These lab results are helpful in diagnosis but not definitive

Hereditary hemochromatosis:
(a) True; (b) True; (c) False, serum ferritin is an acute phase reactant that may be elevated in infection, inflammation or malignancy. Ferritin levels are a poor guide to iron saturation; (d) False, it is the most common inherited disorder in the Western world; (e) False, it may shorten the lives of sufferers, but not those of first-degree relatives

SEND US A DIAGNOSTIC CHALLENGE

We'll send you $100 if we print your diagnostic challenge. Send case description (app. 450 words) with final diagnosis and outcome to: parkex@parkpub.com.

more challenges
subscription   |   advertising information   |   about us   |   contact us   |   privacy statement   |   legal terms of use   |   Doctors review
Oncology Exchange   |   Relay   |   Health Essentials   |   Our Voice   |   login