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Open access, freely available online Learning Forum A 33-Year-Old Man with a Facial
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@MISC{Fleming_openaccess,,
author = {John Fleming and William A. Lynn},
title = {Open access, freely available online Learning Forum A 33-Year-Old Man with a Facial},
year = {}
}
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Abstract
33-y-old man presented to his primary care practitioner with a rash beginning around the left ear and spreading into the periorbital region. He was known to have eczema (atopic dermatitis), and the diagnosis of secondary bacterial infection and periorbital cellulitis was made. Because of a history of penicillin allergy, the patient was started on erythromycin. This treatment had no effect, and the rash extended. On day 4, he presented to the hospital accident and emergency department. He was systemically unwell, complaining of drenching sweats and rigors. On examination he was alert, he was pyrexial at 39.2 °C, his pulse was 100 bpm, and his blood pressure was 128/70 mm Hg. There was a widespread erythematous rash covering his face, chest, and arms, which was described as wet with a yellowish exudate. The rash extended around both eyes, which could not be opened (Figure 1). The patient had a history of atopic eczema (since childhood), rhinitis, and asthma. He was taking inhaled corticosteroids for asthma and had last received a course of systemic steroids one year previously. There were no risk factors for HIV infection. Which Investigations Were Now Indicated? In many patients with a rash, the morphology of the rash will lead to a provisional clinical diagnosis, and it may be sufficiently characteristic for no confirmatory tests to be needed. An example is the typical rash of shingles. There are two broad reasons for doing investigations in a patient presenting with fever and a rash. Firstly, specific tests—such as blood tests, cultures, or a skin biopsy—may be required to The Learning Forum discusses an important clinical problem of relevance to a general medical audience.
Keyphrases
open access confirmatory test broad reason important clinical problem provisional clinical diagnosis general medical audience many patient emergency department systemic steroid risk factor secondary bacterial infection blood pressure atopic dermatitis periorbital cellulitis typical rash hiv infection inhaled corticosteroid skin biopsy 33-y-old man periorbital region specific test atopic eczema left ear penicillin allergy primary care practitioner blood test hospital accident learning forum mm hg yellowish exudate widespread erythematous rash
