19y/o male presents to urgent care with mew onset of rash. N | Figure 1

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19y/o male presents to urgent care with new onset of rash. Noticed 24 hours ago and has been rapidly increasing in size. Rash is non pruritic, non blanching with central clearing. Center of the rash is nodular. No bites noticed by patient. No recent travel.

Otherwise health 12 year old girl with history of R hemimegalencephaly on trileptal and topamax without prodromal illness came home Tuesday evening complaining of razor burn. Rash was scattered and anterior to the BLE but was worse on the LLE. On Thursday evening she complained of the rash again because it was more diffuse. At that time the petechial rash was on both LE circumferentially and on dorsolateral feet. No oral involvement. No conjunctival injection. No fevers. No symptoms. Rash was non blanchable. LLE was worse but that is her hemiparetic side.

Case 2

26 year old male, with no significant past medical history presented with this rash he noted the day before. Located upper flank below right shoulder. No fever, palpable lymph notes or other rashes beside some acne. Non tender.

Case 3

30 yo F with no significant past medical history presents with a rash x 4 days. Rash is flat with ring appearance. Not pruritic or burning. Patient without Just returned from a trip to the mountains but was not in the woods much. No evidence of tick bite. No other symptoms. Does anyone recognize this rash?

Case 4

10 month old male baby presented with a small pimple on right hand, resembling a spider bite. One week later, a circular shape began to form around the affected area. The circular rash is not painful or hot to the touch. Also the child does not have a fever or any other symptoms besides the rash. The child is healthy and does not have any medical history thus far. The rash has progressed slowly and has progressively worsened, forming a more noticeable circle.

Additional Cases

Case 5

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.

Case 6

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.

Case 7

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.

Case 8

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?