Case report: And just one more thing . . .

A 42-year-old, brown-skinned male came to our walk-in clinic this week, having experienced a very sore throat and cough for a week. He had taken Tylenol and gargled with salt water with no improvement. He was otherwise healthy, with no allergies and taking no medications. My examination revealed a red, swollen throat and a wheezy chest, a common combination this winter. I felt he would benefit from antibiotics, and prescribed Amoxicillin and an Advair Diskus inhaler for the cough. As the patient stood up to leave, he asked if he could consult me about “one more thing.” I agreed, and removing his shirt, he showed me a spectacular collection of white areas on his skin. Read: Case report: A winter rash A typical area is shown in the picture of his back. In fact, his entire body was covered in a multitude of a variety of white patches. He thought I might have a new idea regarding treatment. The man reported developing a couple of small spots when he was about six years old. Subsequently, he progressively accumulated many more white areas, which he knew were vitiligo, and attributed the increase to various influences. He believed that the spots came and went quite quickly, and would appear practically overnight (which I doubt) if he ate seafood. Understandably, he had seen a number of dermatologists—in his home country, as well as Canada. He had been subjected to many therapies, including ultraviolet irradiation, injected and topical medications. Nothing helped at all, but he was remarkably cheerful and resigned to his fate. Read: Case report: A travelling rash? The patient enjoyed being asked if a picture could be taken, perhaps considering that widespread exposure might elicit some new therapy. As an add-on question to a more common issue (the sore throat and cough), the dramatic depigmenting vitiligo was interesting, but I could add little to his condition except to recommend avoiding seafood—if he really thought it caused his vitiligo to spread. I am often asked about “one more thing,” but rarely anything as interesting as this patient’s condition. Dr. Robert Dickson is a family physician in Hamilton. This report is based on a real case from Dr. Dickson’s files.

Case report: And just one more thing . . .

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