A 63-year-old male with hepatitis C, use of heroin, and meth (smoking only) developed a skin lesion at the inferior patellar area. Sore originally 2 weeks ago, opened up and deepened over several; has chronic lower extremity edema. I offered to biopsy and he declined for now. He had a positive HIV test recently but confirmatory tests were negative; the viral load was negative. Will plan repeat testing with western blot review - likely false positive but cannot explain low cd4. The view is post-debridement. There was a green-yellow exudate over this. No history of Crohn’s disease. My differential included pyoderma gangrenosum, malignant lesion, Infectious considerations: fungal (blastomycosis, etc) vs mycobacterium. What do you think about the diagnosis? and discuss the management plan

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Since pt is immunocompromised Hiv positive Hepatitis-c positive Presenting with a lesion resembles to burst abscess. If pt was on antiviral for hiv Lesions simulate to IRIS Cd4 count is very low High risk case biopsy is must When you have debride than how pt can deny for biopsy

Thanx dr Kute Ankush
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Immunocompromised pt , *Pyoderma Gangrenous *( Malignant melanoma Inj site Infection or bacterial or fungal ( non healing or non cared wound. Needs further investigation and evaluation to conclude and treatment plan including de addiction .

Thanks Dr SM Sarfraz
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Pyoderma Gangrenosum. In viw of compromized immunitu cause. HIV/ Hepetitis -C positive, melignency must be ruled out ({Mslignent Malanoma.)

Carbuncle in a known immunocompromised status There are very effective regimen for treatment of HIV , namely Dolutegravir, emtricitabine and Tenofovir combination Integrase inhibitor - Dolutegravir is highly effective

IT'S A..CASE OF.. ? CARBUNCLE .. ? PYODERMA .. ? ABSCESS .. TURNED INTO.. ULCER.. NEED'S TO R/O MALIGNANCY..

Tnx Dr Shivraj Agarwal sir
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Why then entertaining him with so much innocent diseases .,..doctors also have the right to refuse.that is the best treatment for him..many thing and in various abnormal presentation it could be as he is intensively immunocompromised already

pyoderma gangrenosum

@ squammous cell carcinoma ?

Immunocompromised pt with malignant ulcer

Provide a detailed information of pt .As it could be dermatitis with fungal infections. Treatment can start stptomatically