Main menu:

Google


Bad Rash

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

History of Present Illness:

A 32-year-old female presents to the ED for a worsening rash.  It has been getting worse for about 10 days.  It was initially itchy, but is now painful.  The rash is on both legs from the belly-button down.  She is on no medications.  She denies recent travel, but does have a dog and two cats.  She denies any fever or other complaints and has never had a rash like this before.

Vital Signs & Physical Exam:

Vital signs are normal.   Physical exam is otherwise normal except for the rash.  See image below.

Initial Differential Diagnosis:

  • Flea bites with severe allergic reaction
  • DIC
  • Vasculitis
  • Disseminated GC
  • Necrotic E. Multiforme
  • Syphilis, the great imitator

Initial Diagnostic Testing:

  • EKG: none
  • Labs: CBC, BMP and LFT’s are all normal
  • Imaging: none

QUESTIONS:

  1. What does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

 

<<<<<<<<<<<<<<<<<<<<< ADVERTISEMENT & SPACER >>>>>>>>>>>>>>>>>>>>>

***************************************************************************

THE EMERGENCY MEDICINE POCKETBOOK TRIFECTA

Tarascan Emergency Department Quick Reference GuideA to Z 3rd ed book cover

Get one of our publications, all designed specifically for Emergency Care Providers:

***************************************************************************

<<<<<<<<<<<<<<<<<<<<<<<<< END SPACER >>>>>>>>>>>>>>>>>>>>>>>>>

ANSWERS:

  1. What does the case image show?  The image shows a dependent vesicular purpuric rash with some necrosis.
  2. What should you do next?  Obtain a sexual history
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample pages below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

CLICK HERE TO LEAR MORE ABOUT THIS BOOK

CASE CONCLUSION: The patient confirmed unprotected sex with a new partner 2-3 weeks before the rash began.  She denied any abdominal or genitals symptoms currently or in the interim.  Wound culture, urine GC, blood culture and delayed labs were all normal.  The dermatologist thought it might be Erythema Multiforme.  Most cases of EM are due to HSV, so this rash could be due to her unprotected sexual exposure.  Most people with herpes simplex don’t actually know they have it.  The biopsy however showed necrotizing leukocytoclastic vasculitis

CASE LESSONS:

  1. A sexual history can be helpful in an unusual rash as disseminated GC and secondary syphilis as well as HIV can present with an unusual rash.  Also, E. multiforme is most frequently caused by HSV and lesions can be large and atypical with skin blistering
  2. Always consider vasculitis or insect bites when the rash is mostly on the legs
:
Google
 
Web www.edinsight.com