Marcus is a 39-year-old man from South America—Brazil to be exact. He has a very dark complexion. He was seen in the dermatologist's office several weeks ago, complaining of several patches of much lighter, almost white areas of skin on his body. The dermatologist's exam showed patchy depigmented macules on the patient's hands, feet, and face. The provisional diagnosis was loss of (skin) pigmentation. The dermatologist did a skin biopsy to rule out other causes. She also ordered labs, which included a comprehensive metabolic panel, serum cortisol, TSH, T3, and T4, and B12 levels. At the time of this visit, the dermatologist reviewed the test results with the patient. The skin biopsy was negative. The labs show abnormal thyroid levels. She also did a more comprehensive exam of the white patches on the patient's skin, and used a Wood's light. The patches glowed bright white under the UV light. Based on the labs, negative skin biopsy, and physical exam, she diagnosed the patient with hyperthyroidism and vitiligo. She discussed the various treatment options available to the patient for treating the vitiligo and the typical progression of the disease. She gave the patient a prescription for tacrolimus and Tapazole. She asked him to return to the office in two months. First-listed diagnosis: Additional diagnoses:
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A non-interest-bearing five-year note for $54600.00 issued May 1, 2015, is discounted April 1, ...