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Hutchinson’s Sign
DOI: https://doi.org/10.21980/J8N040The unilateral distribution of vesicular lesions over the patient's left naris, cheek, and upper lip are consistent with Herpes zoster reactivation with Hutchinson's sign. Hutchinson's sign is a herpes zoster vesicle present on the tip or side of the nose.1 It reflects zoster involvement of the 1st branch of the trigeminal nerve, and is concerning for herpes zoster ophthalmicus.1 Herpes zoster vesicles may present as papular lesions or macular vesicles on an erythematous base.2,3 Emergent diagnosis must be made to prevent long-term visual sequelae.4
Erythema Migrans
DOI: https://doi.org/10.21980/J8QW7QHistory of present illness: A 28-year-old male presented to the emergency department with a chief complaint of two weeks of headache, chills, and numbness in his hands. He reported removing a tick from his upper back approximately two weeks ago, but did not know how long the tick had been embedded. His review of symptoms was otherwise unremarkable. Significant findings:
Chancre of Primary Syphilis
DOI: https://doi.org/10.21980/J83342Physical examination revealed a non-tender, erythematous lesion on the glans penis, two similar adjacent satellite lesions, as well as tender inguinal lymphadenopathy. No penile discharge was noted.
Steven-Johnson Syndrome
DOI: https://doi.org/10.21980/J8661WAt presentation to the ED, a macular rash was notable on all four extremities, trunk and face, and involved mucous membranes of the oropharynx and vaginal introitus. The rash was painful, erythematous and purpuric with targetoid lesions. There were also multiple areas of sloughing and desquamation with a positive Nikolsky sign. Denudement totaled approximately 2% of total body surface area.
Emergency Medicine Dermatology
DOI: https://doi.org/10.21980/J8DW21By the end of this educational session, the learner will: 1) List the six primary types of rash (maculopapular, petechial/purpura, diffuse erythematous, non-erythematous, vesiculo-bullous, and pustular). 2) Be able to accurately describe various types of lesions and rashes with appropriate terminology; 3) Understand the use of the Modified Lynch Algorithm and how it can be used to narrow down the differential diagnosis in patients presenting with rash.
Infectious Mononucleosis: Pharyngitis and Morbilliform Rash
DOI: https://doi.org/10.21980/J88C7HHer physical exam was significant for bilateral tonsillar exudates, cervical lymphadenopathy, and a morbilliform rash that included the palms (Figure 1-4). Laboratory testing was significant for white blood cell (WBC) count of 16.5 thous/mcl with an elevation in absolute lymphocytes of > 10 thous/mcl. The monospot and EBV (Epstein-Barr virus) panel were positive.
Herpes Zoster
DOI: https://doi.org/10.21980/J8C301The patient was in mild distress, afebrile, with stable vital signs. His physical exam revealed an erythematous, grouped vesicular rash in various stages of progression including erythematous papules, clear vesicles, and pustular vesicles. Few lesions were scabbed over. No signs of crusting or scarring were appreciated. The distribution encompassed the entire left T4 dermatome both posteriorly and anteriorly. No other rashes were appreciated elsewhere on the body.
Anaphylaxis Simulation
DOI: https://doi.org/10.21980/J84S3WBy the end of this simulation-based session, the learner will be able to: 1) Recognize and diagnose anaphylaxis according to the criteria set forth by the NIAID and FAAN symposium 2) discuss the appropriate dose, concentration, and delivery route of epinephrine for anaphylaxis 3) list and discuss the rationale for the second-line therapeutic options used to treat anaphylaxis, and 4) develop an appropriate disposition algorithm to be used when managing anaphylaxis in the clinical setting.
Raynaud’s Phenomenon
Photograph contributed by Richard Saunders, DO, FACEP Keywords: Raynaud’s phenomenon, Raynaud’s syndrome.