#IDgrandrounds
35F, from St. Louis, woke up w/ a mildly painful bruise L arm, the next day, +diffuse erythematous rash, fever, abdominal pain. Unremarkable VS/labs. Representative pics of rashes 👇.
Diagnosis? Differentials? @TxID_Edu @BradCutrellMD @Cortes_Penfield @DocWoc71
35F, from St. Louis, woke up w/ a mildly painful bruise L arm, the next day, +diffuse erythematous rash, fever, abdominal pain. Unremarkable VS/labs. Representative pics of rashes 👇.
Diagnosis? Differentials? @TxID_Edu @BradCutrellMD @Cortes_Penfield @DocWoc71
@TxID_Edu @BradCutrellMD @Cortes_Penfield @DocWoc71 1/9
Case continued:
Bruise evolved into an ulcer. On further questioning, reported seeing spider close to her bed prior
CASE RESOLUTION:
Acute generalized exanthematous pustulosis (AGEP) 2/2 spider bite
Pics in MCQ:
medicaljournals.se/acta/content/h…
flickr.com/photos/1448153…
Case continued:
Bruise evolved into an ulcer. On further questioning, reported seeing spider close to her bed prior
CASE RESOLUTION:
Acute generalized exanthematous pustulosis (AGEP) 2/2 spider bite
Pics in MCQ:
medicaljournals.se/acta/content/h…
flickr.com/photos/1448153…
2/9
The rash a/w AGEP is characteristic:
▪️ Diffuse erythema
▪️ Innumerable, pinhead-sized pustules
@TxID_Edu @rloganjonesmd @PVishnuRao1 @alxpenguin @npowah @dschless immediately suspected AGEP! Nice job!
The rash a/w AGEP is characteristic:
▪️ Diffuse erythema
▪️ Innumerable, pinhead-sized pustules
@TxID_Edu @rloganjonesmd @PVishnuRao1 @alxpenguin @npowah @dschless immediately suspected AGEP! Nice job!
3/9
Need to know about AGEP:
【A】 Can be a/w systemic SSX (e.g. fever, transaminitis) but they are usual mild
【B】Rash starts in the face or intertriginous areas (armpits, groins) then spread centrally
【C】Can involve palms/soles BUT the mucosa is spared. Can desquamate.
Need to know about AGEP:
【A】 Can be a/w systemic SSX (e.g. fever, transaminitis) but they are usual mild
【B】Rash starts in the face or intertriginous areas (armpits, groins) then spread centrally
【C】Can involve palms/soles BUT the mucosa is spared. Can desquamate.
4/9
【D】The major cause of AGEP (90%) are drugs 👇.
▪️ Antibiotics
▪️ PPI's
▪️ NSAIDs
【E】Treatment: D/C drugs, supportive +/- topical steroids
Picture from: hindawi.com/journals/drp/2…
【D】The major cause of AGEP (90%) are drugs 👇.
▪️ Antibiotics
▪️ PPI's
▪️ NSAIDs
【E】Treatment: D/C drugs, supportive +/- topical steroids
Picture from: hindawi.com/journals/drp/2…
5/9
Fever ➕ rash invokes a WIDE range of differential diagnoses.
Involves consideration of every aspect of the history (e.g. immune status, drug/travel/exposure history) and exam.
Fever ➕ rash invokes a WIDE range of differential diagnoses.
Involves consideration of every aspect of the history (e.g. immune status, drug/travel/exposure history) and exam.
6/9
One helpful way is categorizing the rash as:
▪️ Central maculopapular (measles, other viral exanthems)
▪️ Peripheral maculopapular (RMSF, syphilis, EM)
▪️ Vesiculobullous or pustular (HSV, VZV)
▪️ Nodular (EN, fungal, Sweet's)
▪️ Purpuric (Neisseria, vasculitis)
One helpful way is categorizing the rash as:
▪️ Central maculopapular (measles, other viral exanthems)
▪️ Peripheral maculopapular (RMSF, syphilis, EM)
▪️ Vesiculobullous or pustular (HSV, VZV)
▪️ Nodular (EN, fungal, Sweet's)
▪️ Purpuric (Neisseria, vasculitis)
7/9
And in this case:
▪️ Confluent/diffuse/desquamative erythema
1⃣ Scarlet fever
2⃣ Staph/Strep toxic shock
3⃣ DRESS
4⃣ SJS/TEN
5⃣ Erythroderma (many causes)
Psoriatic erythroderma previously covered
And in this case:
▪️ Confluent/diffuse/desquamative erythema
1⃣ Scarlet fever
2⃣ Staph/Strep toxic shock
3⃣ DRESS
4⃣ SJS/TEN
5⃣ Erythroderma (many causes)
Psoriatic erythroderma previously covered
8/9
AGEP 2/2 to spider bites has previously been reported:
ncbi.nlm.nih.gov/pubmed?term=19…
ncbi.nlm.nih.gov/pubmed?term=16…
The characteristic rash of spider bite was discussed before. Review here:
AGEP 2/2 to spider bites has previously been reported:
ncbi.nlm.nih.gov/pubmed?term=19…
ncbi.nlm.nih.gov/pubmed?term=16…
The characteristic rash of spider bite was discussed before. Review here:
9/9
At this point, I'd like to refer to @DrStevenTChen and @dschless, our expert dermatologists if they have any other clinical pearls that they can share with us.
At this point, I'd like to refer to @DrStevenTChen and @dschless, our expert dermatologists if they have any other clinical pearls that they can share with us.
@DrStevenTChen @dschless 9/9 EXTRA
Sharing you a schema on an ID approach to Fever and Rash. Feel free to share! #meded
@IDSAMedEdCOP @VarunPhadke2 @JenniferSpicer4 @Cortes_Penfield @EmilyAbdoler @BSchwartzinSF @BonuraErin @TxID_Edu @MohitHarshMD @DocWoc71 @Darcy_ID_doc @BradCutrellMD
Sharing you a schema on an ID approach to Fever and Rash. Feel free to share! #meded
@IDSAMedEdCOP @VarunPhadke2 @JenniferSpicer4 @Cortes_Penfield @EmilyAbdoler @BSchwartzinSF @BonuraErin @TxID_Edu @MohitHarshMD @DocWoc71 @Darcy_ID_doc @BradCutrellMD
