By Tedler D. Depaynos, MD
The patient was noticed to be always wearing a hooded shirt or jacket which covers his face and neck whether the weather is hot or cold. Since he is a private miner, it is only when he is inside his tunnel that his face and neck is exposed. Actually he has been doing this for the past 2 years when his skin lesions became obvious and plenty.
According to him it was four years ago when he developed non-itchy skin rashes initially on his face. He simply interpreted it as “allergy” and he sought no consultation. With time, some of the lesions “got infected” and “ulcerated”. He felt no pain however and because his on and off home medications seem not to be effective, his “lesions” worsened and some got deeper and wider. They multiplied spreading into his neck and his anterior upper chest. It was two years ago that he consulted their family physician and various ointment and oral medications were prescribed. Slight relief was experienced but eventually he discontinued them and did not return for follow-up. Neither did he go to another MD but just relied on some “herbal medications” suggested by his friends and neighbors.
Finally, he was forced again to consult their family physician, but the family physician could not recall seeing the patient. Perhaps, it was due to the length of time or the numerous patients that he has seen for the past two years but he admits that it could simply be the start of memory loss.
Some of the lesions were with well circumscribed edges and deep, even penetrating into the muscles like a tunnel and with oozing pus. Some were with granulation tissues. Since it was four years ago that the patient started suffering these lesions, some healed and obvious scars could be noticed. All the lesions however were all painless and inflammation appeared to be lacking!
His family MD was a little confused and was thinking of referring him to a dermatologist perhaps but when the chest x-ray revealed Tuberculosis or T.B. with a concurrent pneumonia, he now knew the diagnosis. Although an Acid Fast Staining was negative, which was an attempt to identify the bacteria causing the infection, a biopsy of the lesions revealed that it was “consistent with Tuberculosis”.
T.B is always thought to infect the lungs only but actually it could be a systemic disease where involvement of the other organs could occur. There could be involvement of the bones called Pott’s Disease, of the brain called meningitis or involvement of the intestines. In this patient it was his skin and subcutaneous tissues that were involved.
As a rule it is through the lungs that T.B. is acquired. From there, it can spread to all parts of the body through the vascular system. Skin involvement maybe rare but it could happen like in this young patient. The family MD could not recall having a similar case but perhaps it was again due to memory loss.
The patient was given triple anti-T.B. therapy and other medicines but it was emphasized to him that a follow-up is a must.
DAVE AND TANYA
After 16 years of being together Dr. Dave Diamampo and Dra. Tanya Charrissa Depaynos finally tied their permanent knot together last weekend at St. Joseph’s Church and celebrated it at Supreme Hotel. Dr. Dave is a practicing Nuerosurgeon based mainly at Baguio Gen. Hosp’l while Dra. Tanya who finished her Internal Medicine Residency at Capitol Medical Center is now at National Kidney Institute studying to be a Nephrologist. Dr.Dave finished his medicine at SLU College of Medicine while Dra. Tanya at UERMMMC.
The newly weds would like to express their extreme gratitude to those who wished them well especially those who took time to witness their union and joined in the celebration. Many came from out of town and from abroad. Special mention is a “ninong” who had to go to London and convince his wife to come home even for just a few days because he did not like that someone would be assigned to take her place.**
