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Diagnosis Of Sores On Body And High White Blood Cell Count?

Posted on Mon, 17 Mar 2014

Question: Hi Dr., entire body covered in bumps like chickenpox but tests show its not chickenpox or shingles. The craters in the skin are now 1/4 to 1/2 in deep. Soars in the rectum and throat and (high white blood cells). Assuming this is a typical pyoderma as a cutaneous manifestation of Crohn's disease ? Could it be any thing else? What is the best treatments?

Answered by Dr. Dr. Klerida Shehu (9 hours later)

Brief Answer: Please follow the suggestions below.... Detailed Answer: Hi, I have seen your photo and read your medical history. I feel sorry for the bad situation you are in. Before determining that it is cutaneous manifestation of Crohn's disease, I suggest to run further tests to exclude other pathologies: - culture of the discharge or scrapping for candida/bacteria - biopsy of lesions - HIV testing Depending on the test results, specific treatment will be prescribed. Meanwhile, it is a must to start an immediate therapy with: - anti-inflammators - antibiotics -cyclosporine - imunomodulator - corticosteroid -infliximab/ tactolimus I also suggest to consult a dermatologist . I would be glad to assist you further Dr. Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Klerida Shehu (23 hours later)

Hi Dr.Klerida, thanks for your response. I have a update to tell you. Latest tests say it's neutrophilic dermatosis (Sweet syndrome). I assume it was caused by the crohn's ? Will it pass soon and will it come back through life? With this diagnoses what do you suggest for treatment? Also I hear about something called fecal transplants as a treatment for c-difficile, crohn's and colitis. What are your thoughts on that?

Answered by Dr. Dr. Klerida Shehu (12 hours later)

Brief Answer: Following answers to your queries. Detailed Answer: Hi again, Thank you for following up. Yes, you are right in assuming that Sweet syndrome was caused by Crohn's. Please bare in mind that this syndrome is developing in reaction to internal condition (including Crohn's as well), usually referred as extra-intestinal (out of intestines) manifestation of Crohn's disease. This syndrome is more commonly seen in those individuals carrying the genetic marker HLA B54. This condition will pass after the right treatment is initiated. Although studies report repeating back through life; hopefully, it won't be repeated again. The standard therapy for Sweet syndrome include: - local corticosteroids cream - systemic corticosteroids - immunotherapy (immunomodulators) With regards to fecal transplants, I can say that it is a new method to treat persistent c.difficile infection, resistant to treatment in patients with Crohn's disease. Obsiously, the feces of a healthy donor are free of pathogens and parasites. They are inserted in the rectum of the patient. This method is used when the drug therapy is not giving the desired effects. Hope it answered to your queries! Dr.Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Klerida Shehu (4 hours later)

Thanks Dr.Klerida, that helps. If I can ask one more thing of you. I just got a new update that I don't understand : Under the main diagnoses of Neutrophilic dermatosis it says this case falls into 2 categories : #1 pustular pyoderma gangrenosum. #2 pustular / bullous vasculitis. What the hell dose this mean now? Can you explain this to me, thanks for your time again.

Answered by Dr. Dr. Klerida Shehu (19 hours later)

Brief Answer: Further description of your skin problems.... Detailed Answer: Hi again, Thank you for following up. Do not worry about the names of diagnosis you got updated. They are specifically used for treatment and following-up purposes. Usually, the medical terms are difficult to understand and sometimes, misunderstood by the patients. Both of the terms refer to what you are experiencing. Perhaps you have received the biopsy reports which is giving details on the current skin problems you are having. Pustular pyoderma gangrenosum : pyoderma (infection of the skin with pus); pustular (with pustules); gangrenosum (blue-black aged ulcer). Pustular/bullous vasculitis is refering to Neutrophilic dermatosis describing the inflammation of the skin blood vessels. Once again, they are only prescribing in details the current problems of your skin while the final diagnosis is Neutrophilic dermatosis. The treatment and follow up is the same as mentioned earlier. Wish fast recovery! Dr.Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Klerida Shehu (1 hour later)

Great thanks Dr.Klerida, helps a lot.

Answered by Dr. Dr. Klerida Shehu (26 minutes later)

Brief Answer: Glad to know I was of help... Detailed Answer: Hi again, Happy to be assisting you further! Dr.Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Klerida Shehu (45 hours later)

You are awesome!! Could I do a further follow up a little later?

Answered by Dr. Dr. Klerida Shehu (10 hours later)

Brief Answer: yes, you can do other follow up.... Detailed Answer: Hi Thank you Yes you can do other follow up a little later, I will be glad to assist you. Wishing you all the best DR.Klerida

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar