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Have had lesions on body. Suffering from raynauds and neurological symptoms. What should be done?

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Posted on Sat, 4 Aug 2012
Question: I have had lesions on my face, arms chest and back as well as some on legs and feet. This has been going on for over 5 months and some of the original sores are still present and just when i think they are about to heal they come back. they are round and have clear to slightly yellow drainage and bleed excessively when bothered - even when washing face or other affected area. 2 biopsies have been inconclusive but the last stated that while unconclusive the tissue resembled dermititis herpetiforma. (sp?) I am 46 - male - and conncurrently have been suffering from Raynauds and some neurological symptoms and have had a lesion found in the PONs region of the brain. Some speech problems at times (unable to find right word - tongue tied - and problems while reading aloud. I am (or have been generally well spoken in the past until all of this started at the end of October 2011 with a trip to the ER with trouble breathing. That was determined to be bronchial spasm. Never happened before. The skin lesions started early this year (Feb or so) and have not relented a single day since. Pictured are available at my Google+ page ( YYYY@YYYY )
Also to note - just had spinal tap with the following results -

6/18/12 17:06CSFTYPE FLUID/TUBE #: Tube2 GROSS APPEARANCE: Colorless Clear NUCLEATED CELL: 4 /uL RBC: 29 /uL TOTAL # CELLS: 58 total_# NEUTROPHILS: 3 % LYMPHS %: 73 % MONO/MACROPHAGE: 21 % ATYPICAL CELLS: 3 % GLUCOSE SPINAL FLUID: 61 mg/dL (45-75) PROTEIN CSF: 49 mg/dL (20-50) OLIGOCLONAL IG CSF: No oligoclonal immunoglobulin demonstrated. IGG INDEX CSF: 0.52 (0.28-0.66) IGG CSF: 2.6 mg/dL (0.5-5.9) IGG SERUM: 813 mg/dL (694-1618) ALBUMIN CSF: 26.7* mg/dL (13.9-24.6) ALBUMIN SERUM: 4376 mg/dL (3500-5000)

CBC same date
06/18/12 15:48CBCWBC: 6.6 thou/uL (3.9-10.7) Hemoglobin Blood: 12.6* g/dL (14.0-18.1) PCV BLOOD: 38* % (41-49) PLATELET COUNT: 261 thou/uL (135-371) Red Blood Cells: 4.40* mil/uL (4.50-6.00) MCV: 87 fL (81-98) MCH: 28.6 pg (27.0-32.0) Mean Corpuscle Hemoglobin Concentration: 32.8 g/dL (31.0-35.0) RDWSD: 42.9 fL (37.4-52.4) Red Blood Cells Width Distribution: 13.5 % (11.1-14.3)

concerned about the results of lumbar but doctor was only looking for banding and did not understand the rest of the results. he thought they were normal but I have been told otherwise - particularly the number of RBC/WBC/ml and the atypical cells that should not be present. not tube one and not a hot stick.

thanks,

XXXXXX
doctor
Answered by Dr. P V S Prasad (22 hours later)
Hello
Thanks for posting your querry.
It is interesting to go through your history
I think of the following conditions in order of preference.
1. You could be having bullous systemic lupus erythematosus.
The reasons being raynaud,s phenomenon and a space occupying lesion in the pons region
In consistent histo pathology
This could be proved by positive XXXXXXX dsdna tests. If these are negative I think of second choice
2. Polymorphic pemphigoid as lesions are non itchy and not very much bigger in size
3. Dermatitis herpetiformis is a itchy disorder and can be associated with XXXXXXX malignancy. There is no need to worry about few atypical cells in spinal fluid as blood does not show it.
However as skin biopsy is inconclusive only immunoflorescence tests could further give us some clue regarding diagnosis.
Meanwhile pl let me know your medications and if any change in medication if so since when? As blisters or erosions could be induced by drugs.
Awaiting your reply
Prasad pvs
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. P V S Prasad

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Practicing since :1980

Answered : 254 Questions

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Have had lesions on body. Suffering from raynauds and neurological symptoms. What should be done?

Hello
Thanks for posting your querry.
It is interesting to go through your history
I think of the following conditions in order of preference.
1. You could be having bullous systemic lupus erythematosus.
The reasons being raynaud,s phenomenon and a space occupying lesion in the pons region
In consistent histo pathology
This could be proved by positive XXXXXXX dsdna tests. If these are negative I think of second choice
2. Polymorphic pemphigoid as lesions are non itchy and not very much bigger in size
3. Dermatitis herpetiformis is a itchy disorder and can be associated with XXXXXXX malignancy. There is no need to worry about few atypical cells in spinal fluid as blood does not show it.
However as skin biopsy is inconclusive only immunoflorescence tests could further give us some clue regarding diagnosis.
Meanwhile pl let me know your medications and if any change in medication if so since when? As blisters or erosions could be induced by drugs.
Awaiting your reply
Prasad pvs