A thirty-one-year-old female presented to the emergency department with the complaint of a painful rash for 2 days. She has a history of HIV with a known CD4 count < 200 cells/µL. She states that the rash began two days ago and progressed to the current size. She describes the rash as burning and has never experienced these symptoms before. She has tried topical corticosteroids which did not alleviate the pain.
A forty-nine-year-old male with a history of polysubstance abuse, including methamphetamine and intravenous (IV) drug use, rectal cancer, and human immunodeficiency virus (HIV) was brought into the emergency department by emergency medical services (EMS) after he was found down at the bottom of a flight of stairs by his roommate. In the emergency room, he was found to have a Glasgow Coma Scale (GCS) score of 7 and was intubated for airway protection. Non-contrast head CT was performed. Per the roommate, the patient had been “not himself,” exhibiting strange behavior and weight loss. History and review of systems (ROS) were otherwise unobtainable due to the acuity of illness.
A 14 year old girl presenting from Mexicali with altered mental status. Her mother reports a rash about a week ago following a tick bite. She had been going to school until 4 days ago when she became very fatigued with associated vomiting, diarrhea, tactile fevers, and headache. She subsequently collapsed at home today and was difficult to arouse which prompted EMS activation. Her mother denies any prior complaint of neck stiffness, shortness of breath, cough, hematemesis, or hematochezia.
A 62 year old female with no past medical history presented to the ED with fevers, generalized weakness, severe muscle aches, and a rash. She had returned home from the Philippines 3 days prior to evaluation. Twenty-four hours prior to arrival, the patient noticed a rash on her shins. She denied any nausea, vomiting, diarrhea, abdominal pain, chest pain, shortness of breath, cough, sore throat, dysuria, urinary frequency, headache, and neck pain. The patient was in the Philippines for a family funeral and was indoors for most of the trip. She was unsure if she was stung by any bugs or mosquitos.
A 9-year-old male with no past medical history, brought in by his mother to the ER with a new rash on his face and torso. The rash began 10 days ago. On the day he developed the rash, the patient noted swimming in a newly chlorinated outdoor pool. That same day he also played with freshly picked oranges and limes outdoors with his friends, having squeezed the juices onto his head and body. He developed a non-painful, non-pruritic, hyper-pigmented rash on his left cheek.
Over the course of 3 days, the patient and his family went on a trip to a local river, during which the rash evolved to scattered patches on his face and dorsum of his hands with an associated burning sensation exacerbated by contact with hot water or sunscreen. He received outpatient treated by a medical provider at day 3 for presumed infection with both oral and topical antibiotics. He completed the antibiotics, with worsening of his skin lesions. They have since formed blisters and affected his torso.
The patient never had any similar symptoms, or allergies. He had no sick contacts or travel outside the U.S. He denies any history of trauma, thermal burns, or arthropod exposure. The patient has not had fevers, respiratory symptoms, gastrointestinal symptoms, or urinary symptoms.
A 48-year-old male presents with 2 weeks of severe right lower quadrant abdominal pain and inguinal pain. The patient had similar pain 2 weeks ago, was referred to a surgery clinic, but was lost to follow up. The pain has been progressively worsening over the last 2 days. It’s now severe, associated with nausea and vomiting, does not radiate, and it is worsened with coughing and sneezing. He also endorses polyuria for an unknown length of time. His last bowel movement was 3 days ago. He denies diarrhea, constipation, hematochezia, melena, dysuria, hematuria, or recent trauma.
A 65-year-old female without any significant past medical history presented to the emergency department with left eye pain and redness. She also reported a developing rash to left side of her face over the last 24 hours.