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Inside Collection (Textbook): Images of Memorable Cases: 50 Years at the Bedside
This 63-year-old man sought medical attention for abdominal pain of six months’ duration. He also had experienced the recent onset of a gritty yellow discharge from his umbilicus.
On physical examination, this patient had findings that, when taken together, are virtually pathognomonic of actinomycosis: an erythematous, indurated, and tender soft tissue mass in the right paracervical area (“lumpy jaw”); a similar mass in the right axilla; and an indurated, discolored umbilicus with a draining sinus therein. Another draining sinus was evident in the sternum. Cultures of these drainages grew Actinomyces israelli. During a year of penicillin therapy, all of the aforementioned abnormalities resolved.
One other point: This patient also had erythema ab igne (arrows, image below), a permanent brown to red, reticulated, residual pigmentation produced by prolonged exposure to excessive nonburning heat. It came about in this man from his use of a heating pad to relieve the abdominal pain.
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This work is licensed by Herbert L. Fred, MD and Hendrik A. van Dijk under a Creative Commons Attribution License (CC-BY 2.0), and is an Open Educational Resource.
Last edited by Frederick Moody on Dec 2, 2008 10:25 pm -0600.
