Image of the week
Ulcerated nodule on the dorsum of wrist
Nódulo ulcerado en el dorso de la muñeca
Cristina Garrido Colmenero
, Gonzalo Blasco Morente, Israel Pérez López, José María Latorre Fuentes
Corresponding author
Unidad de Gestión Clínica de Dermatología Médico Quirúrgica y Venereología, Hospital Universitario Virgen de las Nieves, Granada, Spain
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She consulted for a painful lump in the back of her left wrist of three months of evolution. The examination revealed an ulcerated nodule with white exudate and erythematous-violet indurated edges (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). She had been taking oral amoxicillin/clavulanate, cloxacillin and ciprofloxacin, and topical clobetasol propionate and mupirocin, without any improvement. We performed a skin biopsy for histological and microbiological study. In the culture, after 4 weeks of incubation, <span class="elsevierStyleItalic">Mycobacterium marinum</span> was isolated. We prescribed oral treatment with doxycycline at doses of 100<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h for 4 months, but the patient discontinued treatment a month and a half later due to digestive intolerance. After treatment with doxycycline injury had improved, but not fully resolved, so we completed treatment with cryotherapy 4 sessions (one session/month), with complete resolution of the lesion after 2 months (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The aquarium granuloma is usually an erythematous and painful nodule; the occurrence as a longstanding ulcerated nodule is atypical and may lead to misdiagnosis, leading to the use of several treatments with no success, as it was the case in our patient. The presence of a longstanding ulcerated nodule that does not improve with regular antibiotic treatment schedule requires to rule out an atypical mycobacterial infection.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Garrido Colmenero C, Blasco Morente G, Pérez López I, Latorre Fuentes JM. Nódulo ulcerado en el dorso de la muñeca. Med Clin (Barc). 2015;145:326.</p>" ] ] "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1243 "Ancho" => 1659 "Tamanyo" => 307570 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1243 "Ancho" => 1658 "Tamanyo" => 371594 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014500000007/v2_201604010141/S2387020616000929/v2_201604010141/en/main.assets" "Apartado" => array:4 [ "identificador" => "43312" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Image of the week" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014500000007/v2_201604010141/S2387020616000929/v2_201604010141/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616000929?idApp=UINPBA00004N" ]
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