SAEM Clinical Image Series: Rash After a Sore Throat and Ibuprofen Use

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Chief complaint: Rash

History of Present Illness: The patient is an 18 year-old male who presents with a rash that appeared 7 days ago. The rash is located on his torso, back, and lower lip. It is pruritic. Three days prior to the appearance of the rash, he had a sore throat and intermittently took ibuprofen over the ensuing 3 days. He stopped taking ibuprofen 4 days after his sore throat abated. He denies any fever, nausea, vomiting, shortness of breath, chest pain, abdominal pain, diarrhea, extended travel in the past year, sick contacts, new soaps/detergents, insect bites, chemical exposure, and new foods.

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By Zachary Smith, MD|2019-07-28T21:17:29-07:00Jul 29, 2019|Dermatology, SAEM Clinical Images, Tox & Medications|

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Chief Complaint: Flu-like symptoms, lip pain/swelling, mouth pain, eye redness, and rash

History of Present Illness: Patient is a 35-year-old transgender male with a history of bipolar disorder (taking seroquel/lamotrigine) who presents with 2 days of:

Flu-like symptoms
Progressive lip pain/swelling
Mouth pain
Oral ulcers
Eye redness
New erythematous rash involving the palms/soles and lower extremities

The patient initially noted myalgias, fever, and malaise 2 days ago. Yesterday, the patient woke up with bilateral eye redness and itching, and he developed lip swelling/discoloration and mouth pain throughout the day. He presented to an outside emergency department (ED) 12 hours prior, where he was told that he had a viral infection, given pain medication, and discharged home. He has not taken any other medications. The patient presents to this ED due to progression of symptoms, including the development of a pruritic rash on his palms, soles, and lower extremities. Upon further questioning, the patient also reports vaginal itching and a fishy odor. He has a history of bacterial vaginosis and states that these symptoms feel similar. The patient denies genital sores, vaginal discharge, and vaginal bleeding. He is currently sexually active with men and women, and does not regularly use barrier protection.

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By Nicholas Stark, MD|2019-07-28T21:30:17-07:00Jul 22, 2019|Allergy-Immunology, Dermatology, Genitourinary, SAEM Clinical Images|

Rash with blood pressure cuff inflation - petechiae

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Chief Complaint: Possible seizure, Left arm rash

History of Present Illness: A 29-year-old with a history of migraine headaches, thalassemia of unknown phenotype, and no history of hypertension or epilepsy arrived to the emergency department via ambulance after possible seizure. The patient had nausea and vomiting the morning after a night of heavy drinking. After several rounds of vomiting, she felt shaky, lightheaded and experienced paresthesia in both of her hands and feet. There was no loss of consciousness, confusion or incontinence. EMS reported hypertension and tremors with upper extremity spasms. The patient developed a left upper extremity rash distal to the blood pressure cuff after paramedics did the first blood pressure measurement.

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By Mallory Hawksworth|2019-07-28T21:32:30-07:00Jul 1, 2019|Dermatology, Heme-Oncology, SAEM Clinical Images|

Welcome to the AIR Cutaneous Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to cutaneous emergencies. 6 blog posts within the past 12 months (as of February 2019) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 3 AIR and 3 Honorable Mentions. We recommend programs give 3 hours (about 30 minutes per article) of III credit for this module.

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By Chris Belcher, MD|2020-09-04T11:11:06-07:00Jun 20, 2019|ALiEMU, Approved Instructional Resources (AIR series), Dermatology|

AIR Series: Cutaneous Module

Welcome to the Cutaneous Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index the ALiEM AIR Team is proud to present the highest quality cutaneous content. Below we have listed our selection of the 4 highest quality blog posts within the past 12 months (as of February 2015) related to dermatology emergencies, curated and approved for residency training by the AIR Series Board. More specifically in this module, we identified 0 AIRs and 4 Honorable Mentions.

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By Andrew Grock, MD|2017-03-05T14:14:16-08:00Apr 18, 2016|Approved Instructional Resources (AIR series), Dermatology|

Diagnose on Sight: Recurrent Rash

Case: A 22 year old female presents with a rash on her left arm for several days. She states she has previously had the exact same rash in the exact same location intermittently over the past 2 years. She has no systemic symptoms and has started no new prescription medications, though she has been taking ibuprofen. What is the diagnosis?

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By Jeff Riddell, MD|2016-12-22T19:23:18-08:00Sep 2, 2015|Dermatology, Diagnose on Sight|

Diagnose on Sight: Diffuse Desquamating Dermatitis

Case: An 84 year old female presents with five days of a diffuse rash. She had a seizure and was started on phenytoin 2 weeks ago. Her mouth, labia, and medial canthi are involved. There are scattered areas of desquamation comprising less than a tenth of her total body surface area. She is tachycardic and febrile. Her complete blood count differential is normal. What is the diagnosis?