History of Present Illness:
A woman in her mid-20’s presents to the hospital with 1 month of worsening LUQ pain that is worse after eating and 20 lbs of weight loss. An outpatient workup has been negative. Her medical history includes a genetic skin condition but she doesn’t remember what it’s called
Vital Signs & Physical Exam:
Vital signs are normal. Physical exam is normal except for LUQ tenderness and the following rash
Initial Diagnostic Testing:
- CBC: normal
- Chem-7 & lipase: normal
- Imaging: US normal
What is the rash and the most likely cause of the abdominal pain?
- A) Abuse & anxiety
- B) Epidermolysis Bullosa and gastric ulcer
- C) Psoriasis and pancreatitis
- D) Food allergy and eosinophilic gastritis
SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT
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ANSWER:
- A) Abuse & anxiety – good thought; abuse is often missed
- B) Epidermolysis Bullosa and gastric ulcer – CORRECT – see below
- C) Psoriasis and pancreatitis – doesn’t look like psoriasis
- D) Food allergy and eosinophilic gastritis
1-Minute Consult on this topic:
EB: Epidermolysis Bullosa: group of rare genetic diseases with fragile skin that blisters easily
Protein defect between layers of skin leading to easy tears/blisters/sores after minor bumps
Comps: Blisters/sores of mouth, esophagus, stomach, intestines, upper airway, bladder, genitals
CASE CONCLUSION: had known Epidermolysis Bullosa. Had endoscopy that showed superficial gastric ulcers