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case 4...rash
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case 4...rash - July 27, 2007 2:24:02 PM
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Dr.Wagner
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Simple but fun case...
Is this infectious? What are your precautions? Would you continue to the the patient?
A 34-year-old, otherwise healthy man is seen in the clinic for treatment of a cervical strain, on exam you notice a pruritic rash on the left lower part of his chest. The patient describes having swelling and pain at the same site 5 days earlier, but these symptoms have since disappeared. He denies having rashes elsewhere, exposure to new medications or foods, having insect or tick bites, or using new soaps or lotions. The patient recently returned from a vacation to a tropical region, where he was snorkeling. However, he cannot immediately recall any unusual exposures or injuries. He denies having fevers, wheezing, difficulty breathing, nausea, or upper respiratory symptoms.
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Dr. Wagner DO
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RE: case 4...rash - July 27, 2007 2:48:18 PM
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FLAOrthoPT
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Honestly now,
I would wear gloves. I would sanitize anything he came in contact with. I would recommend getting that checked out especially because he was out of country. If equiped to do so, I'd check vitals including temperature just to be sure it is something dermatologic and not systemic before moving on. But i have seen a lot worse on patients that we keep treating around. At this point it could be a jellyfish sting, an insect bite, poison ivy or oak, unless there are other symtpoms i am going with universal precautions, and not using the pen I put in my mouth a lot to point at his rash.
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RE: case 4...rash - July 27, 2007 2:50:25 PM
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Shill
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From: Madison WI USA
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He brushed up against coral (?) It is rather uncomfortable, and takes a long time to heal. I would guess topical triple antibiotic such as neosporin routinely, and regular dressing changes would assist.
Oh yeah, Universal precautions.
< Message edited by Shill -- July 27, 2007 3:00:28 PM >
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RE: case 4...rash - July 27, 2007 2:57:17 PM
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JCOY
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Hx of pain and swelling at same site 5 days earlier, unilateral, trunk, -------> makes me suspect Shingles
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RE: case 4...rash - July 27, 2007 6:47:44 PM
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Borneo49
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Well, just off hand, I would use gloves and I think it looks like coral burn.
Borneo49
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RE: case 4...rash - July 27, 2007 9:06:29 PM
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jma
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As said above, I would think he may have brushed up against something while swimming. Were their laboratory tests done and what were the results?I would use universal precautions on anyone regardless of presentation.
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RE: case 4...rash - July 31, 2007 9:33:58 AM
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Dr.Wagner
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Answer:
Type IV delayed hypersensitivity reaction to fire coral: During detailed history taking, the patient describes brushing up against an orange coral with his left torso. He had an immediate burning sensation and urticarial rash, which disappeared the next day. However, 5 days later, a pruritic, vesiculopapular rash appeared in the same location.
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Dr. Wagner DO
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RE: case 4...rash - July 31, 2007 11:05:59 PM
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plhunter
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No Tom, they don't but I lived in Indonesia for 12 years so I am a little familiar with coral. Plus, I'm in Arizona, where there is no coral either.
Borneo 49
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