Category: Physicians

A man in his fifties was admitted acutely for a perforated prepyloric ulcer requiring emergent laparotomy and repair. He was referred to dermatology the next day for incidental painless orogenital ulcers for the past one week. He had a history of recurrent orogenital ulcers for two decades, having 3-4 episodes a year. These ulcers could present in his mouth, on his genitals, or both during each episode; lasting 3-4 days before spontaneously resolving. There were no associated ocular, synovial, gastrointestinal symptoms or chondritis.

A 38-year-old Caucasian male presented to a primary care provider for evaluation recent onset of progressive vision loss as well as multiple submucosal nodules involving the lower lip, right buccal mucosa, gums, and palate. The patient’s medical history included uncontrolled HIV, depression, gastroesophageal reflux disease, and hearing loss. Medications included omeprazole 20 mg once daily; and venlafaxine 150 mg once daily. Social history included occasional marijuana use. Review of systems revealed fatigue, lack of concentration, and a mild headache.

A 61-year-old man first presented in 2013 for evaluation of syncope, fatigue, and Raynaud’s phenomenon affecting his fingers. He had positive speckled pattern anti-nuclear antibodies (ANA), but negative anticentromere and anti-topoisomerase I (anti-Scl-70) autoantibodies. Examination revealed sclerodactyly (Fig. 1A) with skin thickening distal to elbows and ankles, and telangiectasias on face, hands, lips, and tongue (Fig. 1B). A diagnosis of limited cutaneous systemic sclerosis was made. Premature onset of severe trileaflet aortic valve stenosis was also established by echocardiography based on severely thickened, calcified, and non-mobile cusps (arrows, Fig 1C,D), peak and mean gradients of 81 mmHg and 52 mmHg,...