CITW 13: Itch, itch, itch

Welcome back to another Clinical Image of the Week from the case files of the Brown EM Residency!

HPI/ROS: 37 year old male with no significant past medical history presents to the ED with a rash. He states that it began one month ago and has been getting worse. Associated symptom is intense pruritus. It is not painful and nothing of note has made it better or worse. He’s never had a rash like this before. He denies any fevers, chills, shortness of breath, chest pain, myalgia/arthralgias, abdominal pain, nausea, vomiting, diarrhea, or urinary symptoms. He denies any recent exposures (environmental or chemical), medication changes, recent infections, or sick contacts.

Vital Signs: T 98.6, HR 88, RR 14, BP 156/72, SpO2 99% on RA

Pertinent physical exam: Diffuse, papular rash along upper and lower extremities including trunk and back. The neck and face are spared. It is non-blanching, non-weeping, and there are no open sores. It spares the face, lower back, and calves. Patient appears well otherwise. No other pertinent exam findings.

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CITW 6: A Clumsy Foot

Welcome back to another Clinical Image of the Week from the case files of the Brown EM Residency!

HPI: 74 y/o male with multiple medical problems who presents to the ED with four days of left leg pain, left foot numbness, and a new left foot drop. Additionally, his wife points out that she has noticed a new rash extending up his left foot and leg. He denies any fevers, chills, recent infections or trauma to the leg.

Vitals: BP 157/72, HR 77, T 98.8 °F, RR 16, SpO2 97 % on RA

Notable PE: Numbness and rash (see below) noted on the dorsal aspect of the left foot, extending up the lateral aspect of the left leg to the knee. 3/5 strength with dorsiflexion of the left foot.

Rash 1
Rash 2
What’s the diagnosis?

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CITW: Case 3

A 15 y/o male with a history of  diabetes mellitus and hypothyroidism presents to the ED with a diffuse rash. It is not painful or pruritic. Of note, he was seen at the at his primary care doctors office earlier that week and found to have hyperglycemia (400’s) and hypertriglyceridemia (>10,000 mg/dL):

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What’s the diagnosis?

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