What's Your Medical Diagnosis? 82y M, persistent ulcers on hands

#12:1.  The Isabel tool touts an extensive database of conditions for differential diagnosis support, and we often will test its accuracy with real patient cases from the New England Journal of Medicine.

About the Isabel Diagnosis Challenge

The New England Journal of Medicine (NEJM) publishes interesting presentations of common diseases and unusual cases in the Clinical pathology Conference (CPC) series. These cases are educational and can pose diagnostic challenges even to the expert physicians at the Massachusetts General Hospital.

Using the clinical features of these cases you can evaluate your own diagnostic skills and compare your diagnostic performance to that of the physicians at MGH. If you are registered with Isabel as a client or have a free-trial subscription, you can use the diagnosis reminder system and run through some scenarios to get a list of likely suspects. Clicking on a diagnosis will take you through to various knowledge sources and links available from within Isabel.

Today's Case

Demographic: Male, 82 yrs, North America
Clinical features:

• Skin lesions on hand
• dog bite
• hand erythema
• violaceous bullous
• hand lesion
• urticarial and purpuric rash on torso
• thrombocytopenia anemia
• leukocytoclastic vasculitis
• weight loss
• intermittent diarrhea

STOP !
Before you read further, construct your own:

• Complete differential diagnosis 
• Final diagnosis

Differential Diagnoses considered by the MGH panel: Sweet’s syndrome
Final Diagnosis of the case according to NEJM: Pyoderma gangrenosum due to myelodysplastic syndrome
Differential Diagnoses of the case as given by Isabel: Sweet’s syndrome under Neutrophilic dermatoses in Rheumatology
Was the final diagnosis given by Isabel:
Yes, Pyoderma gangrenosum under Neutrophilic dermatoses in Rheumatology