Curious Marks on an Iraqi Man With Respiratory Complaints

Michael J. Zapor
2013 Military medicine  
A 26-year-old suspected Iraqi insurgent is brought to a Troop Medical Clinic in Baghdad, Iraq, with curious marks on his body. On questioning, he describes productive cough, subjective fever, drenching night sweats, and unintentional weight loss. This case shows a condition with which Western physicians are generally unfamiliar but one which quite possibly could be encountered by the deploying provider. CASE REPORT During Operation Iraqi Freedom, a 26-year-old suspected insurgent who was
more » ... nded by U.S. soldiers on patrol in western Baghdad was brought to our Troop Medical Clinic for preconfinement medical evaluation. On questioning, and by means of an embedded translator, the man complained of subjective fever, drenching night sweats, productive cough, and weight loss of several months duration. His symptoms persisted despite then undisclosed treatment by a Baghdadi provider. The patient's physical examination was notable for an afebrile, gaunt-appearing Iraqi man with diminished breath sounds and multiple skin lesions. Each of the seven lesions was roughly palm-sized and well-circumscribed; some appeared inflamed, others ecchymosed, and all had associated linear excoriations. The lesions were distributed symmetrically on the scapulae (Fig. 1) , lower back (Fig. 2) , and distal medial thighs (Fig. 3) . Those on the lower extremities were also notable for the absence of hair in the area surrounding the lesions. A portable chest radiograph showed bilateral patchy airspace disease. A basic metabolic panel and manual white blood cell count were within normal parameters.
doi:10.7205/milmed-d-12-00219 pmid:23820370 fatcat:famh4kimebdppp74rb2c6dxziq