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Simple cases
Case 18
56-year-old man complains of pruritus and little blue spots about his umbilicus and in the genital region
History
What kind of troubles are you having?
I have some blue spots on my groin, scrotum and belly button. They are new and the same areas itch.
The blue spots (maculae ceruleae or taches bleues) are highly diagnostic.
How long have you had these spots?
For about 6 weeks. I kept thinking they would disappear, but I keep getting more.
This slow spread is typical. This dermatosis often remains unnoticed for weeks.
Does your wife have similar lesions?
I have no ideawe are separated.
Important question, as in adults the causative agents are usually transferred by sexual contact.
Have you have sexual contacts in recent months?
Yes, I was in Cuba 2 months ago and had sex few times.
Important question, as in adults the causative agents are usually transferred by sexual contact. This dermatosis may be a sign of promiscuous behavior.
Do you have other complaintsurethral discharge or burning on urination.
No.
Good question. Often patients have more than one sexually transmitted disease at the same time.
Are you willing to have an HIV blood test done?
Is that really necessary? Are these spots connected with AIDS? I always use a condom.
Since this dermatosis is acquired sexually, HIV testing is important. Take time to explain the situation to the patient.
Lesion
Choose the right efflorescences:
False. No fluid-filled lesions are present.
False. No scales are seen.
These small blue lesions are flat and thus macules. They are caused by small amounts of old blood in the dermis following lice bites.
Diagnosis
Choose the right diagnosis:
False. The exanthem of secondary syphilis is more widespread and the patient is usually sick. But syphilis screening is important in this case.
Senile angiomas are usually ruby red papules on the trunk.
Correct. The pubic lice are transferred by sexual contact, spread slowly and leave behind maculae ceruleae when they bite and feed. They typically involve pubic hairs, but occasionally are found in the axillae or on the eyelashes.
False. These are not signs of AIDS, but because the lice are transmitted during sexual contact, HIV screening is important.
Therapy
Choose the right therapy(ies):
False. Topical antibiotics are not useful here.
Good. Lindane is also effective against pubic lice.
Although impossible in this case, always desirable. Only so can the spread of the lice be interrupted.
Correct. Clothing and bedding must be washed at a high setting.
Test
The following questions are related to the current case. Try to solve them.
