Case report: Ringworm?

After years in family practice, working in a walk-in clinic provides a different and unique perspective on medical care. With a relatively fixed population of patients in a family or rostered practice, it is unusual to be presented a new and unexpected problem. The clinic seems to be an environment where one is exposed to a large number of self-diagnoses, unusual perspectives on medical care and widely different expectations. It is not rare for a patient to say (for example): “I bumped my knee on a table yesterday—can I have an MRI?”We all—physician or not—have our own limited vocabulary and experience regarding medical issues. That has to be kept in mind. Nobody knows everything, has seen everything and might have been away during the lectures on something. Read: Case report: Puzzling papulesIt is interesting when a patient presents with a diagnosis—wondering why their treatment isn’t working. An 11-year-old boy was brought to our clinic, his family puzzled by a rash on his chest (see picture). The single, isolated, asymptomatic lesion had appeared two months previously—and had changed little in the interim. He was healthy, with no allergies, taking no medications and had not found his rash to be itchy or sore—just cosmetically unfavourable. He had not been exposed to animals or anyone else with a rash.The rash had been diagnosed by a physician as ringworm—a diagnosis heartily endorsed by the family because of appearance. Despite treatment with topical then oral antifungal medications, the rash had not changed. With a thorough history and perspective gained from his previous—ineffective— treatment, I believed that the lesion was granuloma annulare. It had the characteristic slightly raised border and ring like appearance I have seen previously. I prescribed a trial of Elcon cream (mid-strength corticosteroid).It is humbling to be reminded that a patient can only have a condition that the doctor knows about.Dr. Robert Dickson is a family physician in Hamilton. This report is based on a real case from Dr. Dickson’s files.

Case report: Ringworm?

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