30y/o female with abdominal rash. No history of travel/STD e | Figure 1

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30y/o female with abdominal rash. No history of travel/STD etc. no fever but #Dizziness. Very itchy.

Case 1

36 yo male w hx of type 1 DM, R MCA stroke in 2017, juvenile myoclonic epilepsy (on lamotrigine and topiramate) presented in DKA 2/2 missed medications due to increased sleeping. Over the past year, pt has had almost daily episodes of blurred vision, dizziness, slurred speech and an ?upbeating nystagmus that lasts about twenty minutes. Also noted dysdiadochokenesia and dilated pupils during episode. No focal deficits. Pt oriented and able to speak and follow commands. HDS. After resolution pt is extremely fatigued for 10+ hours. Some nausea and vomiting. No tinnitus or room spinning. EEG unremarkable. Mri neg. Tsh, ammonia, ck, renal, cbc wnl. Pt denies all infectious sxs. Uds neg. During one episode, lactate elevated to 3.7 but has not happened during subsequent episodes. My hospital epileptologist has signed off and said not a seizure. I am starting to wonder about autoimmune encephalitis or something like that? Considering an LP. syphilis pending. Please help this very confused PGY2 figure out what’s happening with this poor guy before I’m forced to discharge him and continue this cycle of having episodes, missing insulin, and presenting in dka.

Case 2

significantly reduced air entry right lung base, c/o RUQ discomfort. No cough, no dysponea, spo3 98%. Bp 137/75. Pulse 96, apyrexial. Systemically well. Vomited 3 days ago. Unable to eat. Lost 2kg in a week. PMH AF with flutter on warfarin. HTN. Investigations WCC12.2

Case 3

An 8 year old patient with 20 hours evolution consisting of non-painful pruritus eruptions that began first on the neck and then on other parts of the body such as abdomen, back and arms, refers to having consumed raisin ice cream 1 hour before the eruptions. With administration of intravenous hydrocortisone, she reported no more itching and rashes on his neck and back, but new ones appeared on his legs, elbows, and abdomen (pictures) without pruritus 6 hours later. Does not report fever, nausea or vomiting, headache, dyspnea, or diarrhea or other symptoms. What would be the possible diagnosis or suggestions? Thanks.

Case 4

A 32yo female patient with no significant h/o medical conditions. presenting with 4 days of the following skin lesion that started after 1 day of localized pruritis. At first she thought it was some mosquito bites, however a few more spots appeared and is now painful. The lesion is localized at the dorsal aspect of the hand between the wrist and the base of the 1st digit. Other than that, there are no other lesions or symptoms.

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