36: Bad Rash

A 62-year old male presents to the ED due to concern for an allergic reaction to oral vancomycin that he has been taking for about 2 months for clostridium difficile colitis.  His other medications include Viramune and Epzicom, which he has been taking for years, but did stop temporarily and then restarted about a month ago.  His T-cells are >400.  There is no fever, no chest pain, and no shortness of breath.  His only other symptom is the ongoing diarrhea, which is watery and occurs 5-10 times a day.  The rash is affecting his entire body and is uncomfortable, but not especially itchy.  (Images are shown below).

His labs are essentially normal.

What is the most likely diagnosis?  What is the treatment? 

BONUS: What other condition(s) should you consider when someone has diarrhea and rash? 

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Get Side-Kick: Emergency Medicine or Quick Essentials: Emergency Medicine

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Answer: ERYTHRODERMA

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EXCERPT ON ERYTHRODERMA

from

QUICK ESSENTIALS EMERGENCY MEDICINE

Basics:   AKA: Exfoliative Dermatitis.  Usually affects >90% TBSA
Exam:    Skin: Red/Thick/Scale, F/C, (edema, CHF, spleenomegally)
Cause:    Skin disease (eczema >psoriasis) >lymphoma >drug reaction >pityriasis, malignancy
Drugs:    ABX, anticonvulsants, viramune
w/u:       Blood Cx, CBC, albumin.  Die of: ID, high output CHF.
Rx:         Supportive as in burn, steroids, treat primary dz. May be life-threatening so admit.

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Bonus: Diarrhea & Rash should also make you consider parasite infection or Pellegra (niacin deficiency) especially if dementia is also present

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