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Rash x 3 weeks

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A 52-year-old male with CAD presents to the ED for about 3 weeks of gradually worsening rash that started as a red patch that was a bit itchy like the one on his right abdomen currently and then in the last 5 days areas started to ulcerate especially the initial rash that is on his left abdomen and then one on his left thigh and then a little bit one on his right thigh. He has never had this before and it has become painful but he denies any fever. No new meds or travel or other complaints.

Vital Signs & Physical Exam:

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

Initial Differential Diagnosis:

  • Syphilis, the great imitator
  • Ecthyma gangrenosum
  • Pyoderma gangrenosum

Initial Diagnostic Testing:

  • EKG: none
  • Labs: 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?

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ANSWERS:

  1. What does the case image show?  The image shows multiple lesions at different stages of evolution most consistent with pyoderma gangrenosum.
  2. What should you do next?  Consider ABX for infection or steroids for PG.  Consult dermatology or arrange for derm f/u.
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page 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

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CASE CONCLUSION: We’ll just have to see

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