Day 3, Thursday April 11
The experience has been amazing so far. The attending and residents are super helpful in explaining what is going on! I have seen more variants of lupus in the last 48 hours than in my entire residency. Yesterday they let me take their pathology quiz from two weeks ago, and it was amazingly helpful in reinforcing my pathology learning. It was also very challenging. There was a histopathology case of penicilliosis, which looks a lot like leishmaniasis or histoplasmosis!
It is interesting in contrast to my time in Tanzania where there is no access to dermatopathology and very limited access to systemic medications. Here they try to reduce costs by using medications like cyclosporine, acitrein, methotrexate, and azathioprine, but they still have access to anti-TNF (etanercept, infliximab, and one patient today on golimumab) as well as ustekinumab (Anti IL-12/23) and secukinumab (Anti IL-17).
I am amazed at how much they know about medications that they do not use frequently. The attending’s knowledge is very up to date on the newest medications coming out for psoriasis (anti- IL 23, guselkumab, tildrakizumab, and risankizumab) and atopic dermatitis (anti IL-31, nemolizumab).
I have also learned several new things, such as the association between pustular psoriasis and anti-IL 37 receptor mutations. I learned about adult onset immunodeficiency with anti-interferon-gamma antibodies. This is associated with neutrophilic dermatoses (such as AGEP-like reaction and sweet’s like reaction). Today we also discussed the association between pemphigus foliaceous, thymoma, and myasthenia gravis (Something that I don’t recall learning, and couldn’t find in Bolognia, but is definitely reported in the literature).
Overall this has been an amazing experience so far. I will say that I am always worried that I am violating some cultural norm without realizing it. I often notice that my voice is just (accidentally) a little louder than those around me, and my movements are a little more abrupt and less confined and careful. I am often probably bowing at the wrong times and in the wrong way, but I am sure I will learn over the next month.