A 34-year old previously healthy man presented with 7 days h | Figure 1
A 34-year old previously healthy man presented with a 7 days history of slightly pruriginous rash on the right side of his abdomen.
The doctor who saw him on the 3rd day of illness concluded that this is herpes zoster and prescribed him acyclovir and gentamicin cream. He took therapy, but rash spread and appeared on another side of the body, both popliteal fossas and around the elbows. He was then referred to me. The pictures show the rash: 1) the right side of the abdomen, 2) and 3) right side of the abdomen and thorax (picture is inverted up-down), 4) close-up of the rash of the right side. There were no typical changes seen in herpes zoster, just this papular rash. I discarded herpes zoster as a diagnosis and sent patient to the dermatologist. I found out that the dermatologist planned biopsy of the rash in the next few days.
What this could be?
Continuation of the previous case
Today, the patient came to follow up visit. He was examined by hematologist and dermatologist. The hematologist didn't think that patient need hematological evaluation for now but ordered follow-up visit in 5 days. The dermatologist disappointed me because she didn't develop any further diagnostic plan, but gave a provisional diagnosis of "papular exanthema" and prescribed one dose of methylprednisolone (patient get it during the visit) and loratadine with fluocinolone acetonide cream. Yesterday, the patient was feeling well, he didn't have a fever or any other complaints. In the evening he developed a fever (this time up to 38,5°C), throat pain, fatigue, and he developed a new symptom - pain in the shins, right knee and lower parts of the arms. He was also feeling occasional pain in the spleen area. The rash was fading from arms (see pictures), but he has it on the sides of the abdomen.
I repeated lab analyses - CRP was 70 (2 days ago was 15), other analyses stayed mostly the same. I ordered serology test (HIV, HBsAg, anti-HCV Ab, M. pneumoniae, Toxoplasma, Parvovirus B19, EBV, and CMV), and with a not probable, but the possible provisional diagnosis of Still's disease sent the patient to rheumatologist for consult, and ordered follow up visit in a few days.
What is your opinion now?
\
5 year old male presents with itchy, painful welts. Originally started off as pimple-like areas (Refer to picture 1) but currently presents as picture 2 on the Left antecubital space and the Left side of the abdomen. Onset on Left antecubital space, 5 days ago. Onset on the Left side of the Abdomen, 2 days ago. Had a fever 3 days ago. Vomited twice 4 days ago. Possibly not up-to-date with vaccinations and has never had chicken pox. Does not go to school yet but does go to day care. Do you think that this possibly can be varicella zoster virus?
A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.
A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.
A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.
Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?