SAEM Clinical Image Series: Sun-burnt Hands and Lips

A 44-year-old Caucasian male with a past medical history of hepatitis C presents with a complaint of pain, swelling, and skin blistering of his hands. He also notes skin sores on his nose, lower lip, and the tops of his ears. The patient claims that these have become progressively worse since starting work a month ago in outdoor construction. The patient denies the use of medications or illicit drugs and denies any medical allergies. He admits to tobacco use and daily alcohol use. The patient denies any other symptoms.

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By Justin Rich|2021-01-30T19:50:28-08:00Feb 1, 2021|Academic, Dermatology, Emergency Medicine, Heme-Oncology, SAEM Clinical Images|

SAEM Clinical Image Series: The Insidious Rash

A 60-year-old African American female with a history of hypertension presents to the emergency department for an itchy, diffuse rash. She first noticed the lesions a few years prior, and they have progressively become larger and more inflamed. The lesions have become severely pruritic over the last couple of months. Steroid creams did not appear to improve symptoms. Currently, the lesions on her arm have become painful with yellow drainage. The patient denies nausea, vomiting, and fever.

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By Monica Mitta|2021-01-20T20:01:42-08:00Jan 25, 2021|Academic, Dermatology, Emergency Medicine, Heme-Oncology, SAEM Clinical Images|

SAEM Clinical Image Series: Red, White, & Blue

A 29-year-old female presented to the emergency department for a rash on her right calf. 5 days prior, at her home in Alabama, the patient developed pain and swelling of her right calf following a spider bite while putting on her pants. The patient felt a “burning pain” and found a spider which she then killed. She went to a hospital and received cephalexin, trimethoprim/sulfamethoxazole, and oxycodone. Despite taking these medications she continued having aching pain rated 10/10 in her right calf along with generalized pruritus. The patient stated that the bite evolved from an initial generalized redness into a blue/black lesion with blistering and extensive redness along her leg and torso. She denied fever, chills, lightheadedness, abdominal pain, nausea, vomiting, and hematuria.

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By Andrew D’Alessandro, MD|2020-10-13T21:07:28-07:00Oct 12, 2020|Dermatology, Emergency Medicine, Environmental, SAEM Clinical Images, Tox & Medications|

SAEM Clinical Image Series: Severe Cutaneous Lesions in an Immunocompromised Host

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.

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By Rykiel Levine, DO|2020-08-18T09:09:28-07:00Aug 17, 2020|Dermatology, Emergency Medicine, Infectious Disease, SAEM Clinical Images|

IDEA Series: Use of gamification through Clue: Pediatric Rash Edition

Emergency Medicine (EM) physicians care for anyone, with anything, at any time. This includes pediatric patients as well as adults. For those without advanced pediatric training, “sick kids” can be quite intimidating. Rashes in the pediatric population are often benign, but in rare cases they portend significant illness. Rashes are also frequent chief complaints; In 2015, there were 1,452,300 pediatric ED visits for “skin and subcutaneous tissue disorders” [1]. We sought to improve the teaching of pediatric rashes in our residency curriculum.

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By Peter Tomaselli, MD|2020-05-05T16:22:24-07:00May 13, 2020|Dermatology, IDEA series, Pediatrics|

SAEM Clinical Image Series: Fever and Aches

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.

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By Brianna Miner, MD|2020-01-13T15:24:23-08:00Jan 13, 2020|Dermatology, Infectious Disease, SAEM Clinical Images|

SAEM Clinical Image Series: A Multifactorial Skin Eruption

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.

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By Erwin Kong, MD|2019-12-23T18:35:31-08:00Dec 24, 2019|Dermatology, SAEM Clinical Images|

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