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Yeast Infection?

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A 62-year-old male presents to the ED for a rash.  He has been on medications for possible fungal and possible bacterial infection in his legs for about 10 days but he feels like he is getting worse. ?He is having itching and scaling but no fever or pain except in his bilateral ankles where he has the most skin cracking and some weeping. ?He has never had this before. ?He states he recently changed detergents and started putting Pine-Sol in his laundry to disinfected because he is sharing laundry with other people in his apartment building. He denies  or other complaints

Vital Signs & Physical Exam:

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

Initial Differential Diagnosis:

  • Tinea
  • Allergy
  • Cellulitis
  • Syphilis, the great imitator

Initial Diagnostic Testing:

  • EKG: none
  • Labs: CBC and BMP 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 CONTACT DERMATITIS.
  2. What should you do next?  Treat with steroids.
  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: Gradually improved with topical steroids and return to prior detergent

CASE LESSONS:

  1. Don’t anchor on a prior diagnosis
  2. Consider contact dermatitis from detergents in areas with more pressure from clothes (socks, waist line…)
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