Case of multiple cellulitis, or...something more obscure?

A 68-year old man with acute illness which started 10 days ago when he noticed redness of his right knee without other symptoms. During same day in the night he started to feel pain in his right shoulder, and shortly after that he noticed redness in the front of that joint and started to feel pain in this area. Soon after that he spiked fever up to 39°C, and he noticed neck and supraclavicular pits swelling which started to be painful. Also he started to feel pain in his left knee which also become red. He was examined a few days later and he was given antibiotics for presumed cellulitis. He was taking medicine, but beside defervescence and slight reduced swelling of the right shoulder, he didn't notice any improvement. Now he is coming for pain in all his body, most prominently in the upper part of the body, and in the right shoulder which has reduced movement because of pain. In the area of his left knee redness, there is now something that looks like a skin abscess.

The pictures are showing the most prominent features that are seen on the skin - right shoulder redness and induration with tiny pustules (white matter is the cream he applied), both knees have redness in the front, and he has purpuric rash around his ankles which appeared today. The rest I will describe in the comment, because I have not enough space here.

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UPDATE: The gentleman came for a follow-up visit to my office. He is taking doxycycline as I prescribed, and now, the skin changes are in regression as seen in the picture, he is feeling only itch in the area of most prominent redness. He doesn't have any complaints. The laboratory work-up showed normal CBC and CRP. I advised continuation of therapy for 21 days under suspicion of first stage of Lyme disease.

This patient has been diagnosed since his childhood with dermatitis. Most of the time during the past 12 years he was on corticosteroid creams. Last 1.5 years his symptoms have worsened without change of diagnosis. His forehead is very red and bumpy, he says that it has burning sensation and feels uncomfortable. Also the skin changes rapidly in terms of texture and pimples, for days it can be fine and then suddenly worsening. He notices that when he changes the room where he sleeps his symptoms can improve or get worse. His arms have red spots that are itchy and he scratches them every day. Is this maybe scabies on hands and rosacea on the face or something else some allergy?

A 65-year old woman referred to me because of 2 day skin change on the inner side of the left knee. She was working in the field, and after she came home she noticed redness and two punctiform lesions in the middle in mentioned area. During next day, the redness progressed, and she is now feeling pain in the region with skin change. There is no fever, other symptoms. On exam, I noticed smaller livid redness in the middle, which is indurated and raised from surrounding skin with small pit in center, and bright redness around, which blanch with pressure. The whole area is warm on touch, and painful. There is no lymphadenopathy. The rest of the exam is normal. My thinking is that this is most likely some reaction to some insect bite. Infection is also a possibility. Despite its look, because of symptoms and quick progression of lesion, I would not consider erythema migrans. What is your opinion? P. S. The brown spot on the picture is some stain on my camera, not on the skin of the patient.

83 yo female. History of corpus cancer and colon cancer both 2010. Single treatment for low grade hypertension, dose unchanged for many years. Occasional HSV cold sores. One episode of erythema multiforme about 20 years ago. Noticed the above lesions on the back of right thigh about 4 weeks ago when an oval flap of layered skin fell on the floor after a bath. No itching or pain. Single biopsy taken by GP 3 weeks ago, results pending. Noticed upper lesion on thigh about 2 weeks ago and lesion on right shoulder (image 3) about 1 week ago. Redness reduced with Betnovate but returned on discontinuation. Tinea? Bullous pemphigoid? I would have expected both to itch.

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?