The patient is an elderly woman who was primarily being looked after by private nurses since her family had moved abroad. Every once or twice a year, they visit her and find her confined in a hospital. A couple of years back, she had a stroke from which she wasn’t able to recover from. She was bed ridden, ate poorly (eventually had PEG placed) and had recurrent urinary tract infection and pneumonia.
On this admission, it was fairly routine for the family. Almost instantly, without any tests or consults yet, they had labeled her ill with pneumonia or UTI again. Good assumption, but as I saw the patient in her room while being turned, her entire back and sacral regions were covered with keratoses. I wasn’t the only one surprised, as this was the first time her son had this too. I asked her nurses and they told me the lesions were there when they started taking care of her 5 years ago.
Dermatology is not my strength but I saw a similar lesion before from a lecture in medschool on cancer (because the one who gave the lecture was my favorite consultant – ever). I had to look for my old lectures and found it similar to Leser Trelat. But in my review of her medical history, she was never worked up for any malignancy. This is the first time I have ever seen this lesion, so I suggested workup for any possible signs of cancer. Since she was in the hospital for loose stools and anorexia, I started in the gut. Whole Abdominal CT scan would later reveal a mass in the colon. But since the patient is elderly (89 years old), her family did not want to do colonoscopy / biopsy anymore.
*Photo posted with permission from relative