Diagnostic Assessment — Groin - Tinea Cruris
Example 1 of 1 · fictitious patient (Veteran A)
Diagnostic Assessment
Groin - TINEA CRURIS
SOP No. 55 of 2024 (Reasonable Hypothesis) - Tinea SOP No. 56 of 2024 (Balance of Probabilities) - Tinea
ADF History
The veteran, Date of Birth: [withheld] Aircraft Technician, enlisted on 18 Apr 1988, discharged on 22 October 1999.
Occupational History
As an Aircraft Technician in the Royal Australian Air Force, the veteran the veteran was exposed to numerous occupational hazards including aviation fuels, hydraulic fluids, lubricants, solvents, adhesives, paints, and cleaning agents. His role involved working in confined spaces such as fuel tanks, which required specific medical clearance and monitoring. Physical demands included awkward postures during maintenance, heavy lifting of aircraft components, exposure to vibration from power tools, and repetitive movements.
Environmental hazards included extreme temperatures, poor ventilation in confined spaces, exposure to fuel vapors, and outdoor work with UV radiation exposure. He was specifically documented as having Fuel Tank Entry (FTE) duties, which would have involved regular exposure to chemicals in enclosed spaces.
History
The veteran an Aircraft Technician in the Royal Australian Air Force, developed tinea cruris (jock itch) in January 2000. The condition was noted when he presented to medical staff reporting that a back rash had spread over his buttocks after showering.
Timeline
- 13 Dec 1997. The veteran presented to morning sick parade with a back rash that had started 1- 2 days prior. The rash was described as prickly heat / heat rash and was itchy. He was advised to take Claratyne (antihistamine) and apply Bepanthen cream.
- 15 Dec 1997. The veteran returned to the medical facility reporting that the rash on his back had changed and spread over his buttocks following a shower. He stated they had come real bad when leaning after shower. He was advised to check with the Medical Officer and a review in 1-2 weeks was noted.
Symptoms
Initial symptoms included an itchy rash on the back that was initially diagnosed as heat rash. Subsequently, the rash spread over the buttocks area, particularly worsening after showering,
which is consistent with tinea cruris. The rash appeared to be exacerbated by moisture and heat, which aligns with the typical presentation of tinea infections.
Current symptoms based on the available documentation are not clearly detailed. However, tinea cruris typically presents with red, raised, scaly patches with well-defined borders in the groin and inner thigh area. It generally causes significant itching and discomfort, particularly in warm, humid environments or after physical activity.
Imaging
No imaging studies relevant to tinea cruris were documented.
- What is the formal diagnosis of the condition claimed above? The formal diagnosis is Tinea Cruris (Jock Itch), with DVA SOP Instrument No. 55 of 2024 (Reasonable Hypothesis) and No. 56 of 2024 (Balance of Probabilities), and ICD-10 code B35.9.
Tinea cruris, commonly known as jock itch, is a fungal infection of the groin and adjacent skin areas caused by dermatophyte fungi. These fungi, which include species of Trichophyton, Microsporum, and Epidermophyton, thrive in warm, moist environments and can be spread through direct contact with infected individuals or contaminated surfaces. The infection typically presents as a red, itchy, ring-shaped rash with a raised, scaly border that extends from the groin folds to the upper thighs. It is more common in men than women and is frequently associated with factors that promote warmth and moisture in the groin area, such as tight clothing, sweating, and inadequate drying after bathing.
Based on the available documentation, there is only one instance of suspected tinea cruris documented for this veteran.
- For each diagnosis identified, please also provide the following dates: When did the veteran first experience symptoms attributable to this condition? The veteran first experienced symptoms attributable to tinea cruris on approximately February 21-22, 2002, when he initially developed a rash on his back that was described as heat rash or prickly heat.
When did the veteran first present to a health / medical provider for this condition? The veteran first presented to a health provider for this condition on February 23, 2002, when he reported to the morning sick parade with a back rash that had started 1-2 days prior.
When was the condition confirmed / formally diagnosed? The condition was not explicitly confirmed or formally diagnosed in the available medical records. On February 25, 2002, there was recognition that the rash had spread to the buttocks after showering, and the veteran was advised to check with the Medical Officer, but the follow-up and formal diagnosis are not documented in the available records.
When did the veteran first present to you (or your practice) for this condition? March 15, 2022
- How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions? Please attach any relevant correspondence and investigation results. The diagnosis of tinea cruris is supported by the documented clinical features and progression of the rash. Key symptoms and signs include:
- Initial presentation of an itchy rash initially on the back, described as heat rash
- Progression of the rash to involve the buttocks area
- Worsening of the condition after showering (which is consistent with the behavior of fungal infections in moist environments)
- Pattern of spread consistent with tinea cruris, which commonly affects the groin, perineal region, and can extend to adjacent areas
While a definitive diagnosis typically involves microscopic examination of skin scrapings or fungal culture, which were not documented in the available records, the clinical presentation is highly suggestive of tinea cruris, particularly given the spreading pattern and exacerbation after exposure to moisture.
- What do you consider to be the cause(s) of the condition in this veteran? Give consideration to constitutional and common risk factors, pre-existing injuries or diseases, and occupational or lifestyle risks, as well as direct causative mechanisms.
having unprotected physical contact with: (a) a person infected with tinea; (b) an animal infected with tinea; (c) objects or surfaces contaminated with dermatophytes; (d) using communal showering or bathing facilities, swimming pool facilities or locker rooms; (e) soil contaminated with dermatophytes; or (f) a site of tinea on the same body; between 2 days and 3 weeks before the clinical onset or clinical worsening
- MET. The veteran the veteran was an Aircraft Technician in the RAAF and would have regularly used communal showering facilities on base. Military personnel typically share bathroom facilities, locker rooms, and living quarters, which are common transmission points for tinea. Additionally, the spreading of the rash from the back to the buttocks area suggests potential self-spread from one body area to another.
having skin maceration at the affected site between 2 days and 3 weeks before the clinical worsening
- MET. The medical record specifically notes the condition worsened after showering, indicating skin maceration likely played a role in the worsening of the condition. Additionally, as an Aircraft Technician performing Fuel Tank Entry duties, the veteran would have experienced heavy sweating in the confined spaces of aircraft fuel tanks, particularly in the the state climate, leading to prolonged periods of skin maceration in the groin area.
having diabetes mellitus at the time of clinical worsening
- NOT MET. There is no evidence of diabetes mellitus in the available medical records.
having a substantially lowered immune function at the time of clinical worsening due to: (a) human immunodeficiency virus (HIV) infection; (b) glucocorticoids other than inhaled glucocorticoids; (c) solid organ transplant (excluding corneal transplant), stem cell or bone marrow transplantation
- NOT MET. There is no evidence of substantially lowered immune function in the available medical records.
having topical glucocorticoid applied at the site of the tinea at the time of clinical worsening
- NOT MET. There is no evidence of topical glucocorticoid application in the available medical records.
inability to obtain appropriate clinical management for tinea before clinical worsening
- MET. The medical records indicate that while the veteran was advised to check with the Medical Officer for his spreading rash, there is no documentation of appropriate antifungal treatment being prescribed or administered. The Full Federal Court in Brew v Repatriation Commission (31 Jun 1993) enlarges on the meaning to be given to "inability" as the lack of ability to get treatment in both an objective and subjective sense. In this case, the veteran appears to have presented with a condition that was initially misdiagnosed as heat rash, and when it spread, he was advised to see a Medical Officer but no documentation of appropriate antifungal treatment is present. This constitutes barriers to healthcare and inability to attain appropriate medical management.
This condition occurred during the veteran's ADF service period prior to July 1, 2002, and did not occur on warlike deployment, so it falls under DRCA legislation. While the SOP factors are analyzed above, technically the factors do not legally apply under DRCA. However, the analysis against these factors demonstrates the likely service-related nature of the condition.
Sequelae
There is no evidence that this condition is a sequelae of another known condition.
Unintended Consequence
There is no evidence that this condition is an unintended consequence of medical management.
Inability to Attain Appropriate Medical Management
The medical records suggest an inability to attain appropriate clinical management for tinea cruris. The veteran initially presented with what was described as heat rash and was given Claratyne (an antihistamine) and Bepanthen cream, neither of which are appropriate treatments for fungal infections. When the condition worsened and spread, he was advised to check with a Medical Officer, but there is no documentation of antifungal treatment being prescribed or administered.
The Full Federal Court in Brew v Repatriation Commission (31 Jun 1993) (see the judgment of Merkel J) enlarges on the meaning to be given to "inability" as the lack of the ability to get the treatment in both an objective and subjective sense. In this case, the misdiagnosis of the condition as heat rash rather than a fungal infection represents an objective barrier to obtaining appropriate treatment. The absence of documented follow-up or antifungal treatment after the condition was noted to have spread suggests that appropriate clinical management was not obtained.
This inability to obtain appropriate clinical management would have caused a permanent worsening by allowing the fungal infection to establish more firmly, spread to additional areas, and potentially develop resistance to first-line treatments, making it more difficult to eradicate subsequently.
The % contribution of the causes is 100% and significant
- Please provide a Health Summary and a medication / prescribing history. -see attached report
