Wednesday, March 23, 2005

34 year old man with multiple erythematous plaques

Recently I saw this interesting patient: a 34 yr old factory worker presented with redness over the thigh and lower abdomen for a week. Started as "burning discomfort" over the left knee and then spread to the right knee, thigh and lower abdomen. He has no fever. No history of diabetes. He denied any insect bite. There was no preceding drug history.
Examination showed diffuse and glistening redness on the thighs and lower abdomen. On the right thigh, there was a single non hemorrhagic blister. Regional nodes were not enlarged. The lesion was not particularly tender. He was afebrile.





Impression: cellulitis - right thigh. Unusual site for cellulitis though. what is your take on this patient?

Henry
at

3 comments:

  1. Humane Medicine HuiMarch 23, 2005

    The look of the lesions and the lack of systemic symptoms would make me think of some kind of chemical burn. I have seen this with ethylene oxide, but any stron acid or alkalik could do this.

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  2. ksharquieMarch 30, 2005

    This is the first attack of Fixed Drug Eruption.Pleae look for the culprit drug.

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  3. Dr. Shahbaz A.JanjuaApril 01, 2005

    I have not seen such an extensive case of Lyme disease but still my first impression was this diagnosis. Tick bites are usually painless and can also cause blisters. The joint involvement is also suggestive.
    If the lesions are not tender and the patient is also afebrile, cellulitis is unlikely in my opinion.
    If the patient presented with short history, a therapeutic trial of tetracyclines would be worthwhile.

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