23076693 Visualization

A 45 Age - year Age - old Age lady Sex sought dermatology Clinical_event consultation Clinical_event for severely Texture tender Texture erythematous Detailed_description vesicles Sign_symptom and bullae Sign_symptom over back Biological_structure , chest Biological_structure and arms Biological_structure .
These Coreference were sudden Detailed_description in Detailed_description onset Detailed_description associated with fever Sign_symptom , nausea Sign_symptom and malaise Sign_symptom .
Along with this she also complained of pain Sign_symptom in upper Biological_structure abdomen Biological_structure .
There was no History history History of History receiving History any History drugs History prior History to History the History onset History of History lesions History .
She did not report any significant Detailed_description weight Sign_symptom loss Sign_symptom or loss Sign_symptom of Sign_symptom appetite Sign_symptom .
On physical Diagnostic_procedure examination Diagnostic_procedure , her temperature Diagnostic_procedure was 38°C Lab_value , pulse Diagnostic_procedure rate Diagnostic_procedure was 100/min Lab_value and blood Diagnostic_procedure pressure Diagnostic_procedure was 126/72 Lab_value   mm Lab_value   Hg Lab_value .
There were multiple Lab_value coalescing Detailed_description vesicles Coreference and bullae Coreference over upper Biological_structure back Biological_structure , chest Biological_structure and arms Biological_structure distributed Detailed_description symmetrically Detailed_description showing areas of pustulation Sign_symptom and necrosis Sign_symptom .
Surrounding Other_entity them Coreference were multiple Lab_value pseudovesicular Detailed_description satellite Detailed_description papule Sign_symptom (figure 1A,B).
On per abdominal Diagnostic_procedure examination Diagnostic_procedure mild Severity tenderness Sign_symptom was present in the right Biological_structure hypochondrium Biological_structure .
Patient's initial laboratory Diagnostic_procedure investigations Diagnostic_procedure showed a total Diagnostic_procedure leucocyte Diagnostic_procedure count Diagnostic_procedure of 12 Lab_value   000 Lab_value cells/mm3 Lab_value with 75% Lab_value neutrophils Lab_value .
The haemoglobin Diagnostic_procedure level was 14.3 Lab_value   gm% Lab_value and erythrocyte Diagnostic_procedure sedimentation Diagnostic_procedure rate Diagnostic_procedure was 30 Lab_value  mm/h.
Liver Diagnostic_procedure function Diagnostic_procedure test Diagnostic_procedure , kidney Diagnostic_procedure function Diagnostic_procedure test Diagnostic_procedure and C Diagnostic_procedure reactive Diagnostic_procedure protein Diagnostic_procedure levels were within normal Lab_value limits.
Gram Diagnostic_procedure stain Diagnostic_procedure from purulent Diagnostic_procedure exudates Diagnostic_procedure showed only neutrophils Biological_structure without any organisms Sign_symptom and culture Diagnostic_procedure did not show any growth Sign_symptom after 72 Duration   h Duration of Duration incubation Duration .
A lesional Detailed_description skin Biological_structure biopsy Diagnostic_procedure taken from the satellite Detailed_description papule Coreference showed neutrophilic Sign_symptom infiltration Sign_symptom in dermis Biological_structure with papillary Sign_symptom dermal Sign_symptom oedema Sign_symptom and spongiosis Sign_symptom (figure 2A,B).
Abdominal Biological_structure ultrasonography Diagnostic_procedure revealed intraluminal Detailed_description gall Biological_structure bladder Biological_structure mass Sign_symptom suggestive of malignancy Sign_symptom .
On the basis of these findings a final diagnosis of SS Disease_disorder associated with gall Coreference bladder Coreference malignancy Coreference was made.
She was started on oral Administration prednisolone Medication in dose of 40 Dosage   mg Dosage daily Frequency along with symptomatic Detailed_description treatment Medication .
Her cutaneous Detailed_description lesions Sign_symptom responded dramatically and subsided Detailed_description completely Detailed_description after 1 Duration   week Duration of treatment Medication (figure 3A,B).
Dose of prednisolone Coreference was tapered Clinical_event and an open Detailed_description cholecystectomy Therapeutic_procedure was performed.
Histopathology Diagnostic_procedure of excised Biological_structure tissue Biological_structure confirmed it to be well Detailed_description - differentiated Detailed_description gall Biological_structure bladder Biological_structure adenocarcinoma Disease_disorder forming glands Biological_structure and Sign_symptom papillae Biological_structure infiltrating Sign_symptom the Sign_symptom muscularis Biological_structure propria Biological_structure superficially Detailed_description .
Cystic Biological_structure duct Biological_structure cut Biological_structure margins Biological_structure were free of tumour Sign_symptom (figure 2C,D).
Patient's postoperative Duration period Duration was uneventful Sign_symptom and she was discharged Clinical_event on tapering Dosage doses Dosage of prednisolone Coreference with advice to follow-up periodically.