|
Ensure delivery by adding imagecase@email.emedicine.com to
your address book
BACKGROUND
A 22-year-old, otherwise healthy, Caucasian man presents
to the emergency department with what appears to be a
scaly, verrucous rash involving the side of his nose
(see Image 1), his left shoulder (see Image 2), the
right side of his back, and the left posterior aspect of
his thigh. He has recently moved to California's Central
Valley but denies having any unusual exposures or
medical problems and is not taking any medications.
The review of symptoms yields negative findings for
fevers, night sweats, and chills. Methicillin-resistant
Staphylococcus aureus (MRSA) is initially diagnosed, and
the patient is presumptively treated with
trimethoprim-sulfamethoxazole and rifampin and
discharged home. Several weeks later, he returns to the
clinic because the "rash" was not improving and he now
has night sweats and arthralgias. Consultation with a
dermatologist leads to biopsy of the lesions.
What is the diagnosis? |
Hint
The patient developed symptoms after moving
to California's Central Valley. |
|
Authors:
|
Rachel U. Lee, MD,
Internal Medicine Department,
Naval Hospital
Lemoore, Calif
James T. Stasiak, MD,
Branch Medical Clinic,
Naval Hospital
Lemoore, Calif
|
|
|
|
eMedicine
Editor:
|
Rick G. Kulkarni, MD,
Assistant Professor,
Yale School of Medicine,
Section of Emergency Medicine,
Department of Surgery,
Attending Physician,
Medical Director,
Department of Emergency Services,
Yale-New Haven Hospital, Conn
|
|
|
|
|
|
|
