A 46-year old male patient with a history of hypertension an | Figure 1

BorisJ87

Case Description

A 46-year-old male patient with a history of hypertension and diabetes mellitus type 2 presented with a 5-day history of pruriginous and slightly tender rash on his left lower arm and hand (picture no. 1, 3 & 4), right arm (picture no. 5), and right feet (picture no. 2). He was using some creams but without improvement except on the right foot where skin changes started to disappear. He was referred to me because of a suspicion of herpes zoster.

The patient stated that he started to use the anti-alcoholic drug on its own, 10 days before the current presentation, which is called acamprosate.

I discarded HZ as a diagnosis and referred the patient to the dermatologist.

What could this be? Is it drug related or is it something else?

Images

1. 2. 3. 4. 5.

Additional Cases of Interest

  1. 60 years old male. Smoker, COPD, Diabetic, underwent whipple surgery 14 years ago because of pancreatic cancer. Current treatment includes metformin 1g per day plus 6 units of NPH insulin. The patient has a history of deep venous thrombosis on the right leg 2 weeks ago and started warfarin 5mg per day. Weight is 42kg. He reports pain in the upper back and difficulty moving shoulder and left arm. View Case

  2. 37-year-old female with no past medical history. Presented to the office with a rash that started 24 hours after gardening. The rash began as a streak on the arm and kept spreading. This picture was taken on day 7 after the grading; the rash continues to worsen and is itchy. Prescribed prednisone for 20 days starting at 60mg. Unsure if it’s a result of poison ivy or a fungal infection. View Case

  3. 76-year-old male, diabetic, with a history of fever 5 days ago and appearance of pustules on the body and mouth. Claims it started in the mouth and then spread to the arms, back, stomach, and lower limbs. Occasional itching present. View Case

  4. A 52-year-old female presented with an 8/10 pain scale, unable to move her right arm, referred for PT. No history of trauma but with swelling; pain onset occurred 3 weeks before x-ray. Scheduled for an MRI next week. Did the ortho miss anything? View Case

Inquiry and Thoughts

If you have insights or recommendations based on the case description, feel free to ponder what might be drug-related versus another condition.