Rash and edema

[Ne-Blondinka]

Ну вот такой вопрос. Patient is 55-60 yo. Presents with severe pruritis, which within a day evolves into a very erythematous, papular rash, raised and blanching, inolving trunk/extremities. Over a couple of days, also develops marked edema of hands/arms only. No facial or leg edema. No fever, no preceding URI symptoms, etc. Had a sick contact with someone who had fever, cough, sore throat a few days before that. Pt goes to his doctor, who diagnoses him with an "allergic rxn", sends him home on Benadryl. Bloodwork /UA is negative. All symptoms resolve within one week or so, but then the rash reappears. Pt has no known allergies, takes a few meds chronically but denies taking any new meds.

Что бы ето могло быть? ДоХтора, что скажете?

[Donat]

Ну вот такой вопрос. Patient is 55-60 yo. Presents with severe pruritis, which within a day evolves into a very erythematous, papular rash, raised and blanching, inolving trunk/extremities. Over a couple of days, also develops marked edema of hands/arms only. No facial or leg edema. No fever, no preceding URI symptoms, etc. Had a sick contact with someone who had fever, cough, sore throat a few days before that. Pt goes to his doctor, who diagnoses him with an "allergic rxn", sends him home on Benadryl. Bloodwork /UA is negative. All symptoms resolve within one week or so, but then the rash reappears. Pt has no known allergies, takes a few meds chronically but denies taking any new meds.

Что бы ето могло быть? ДоХтора, что скажете?

insufficient info
a wild guess ;)
some small vessel vasculitis

[Malishka]

Ну вот такой вопрос. Patient is 55-60 yo. Presents with severe pruritis, which within a day evolves into a very erythematous, papular rash, raised and blanching, inolving trunk/extremities. Over a couple of days, also develops marked edema of hands/arms only. No facial or leg edema. No fever, no preceding URI symptoms, etc. Had a sick contact with someone who had fever, cough, sore throat a few days before that. Pt goes to his doctor, who diagnoses him with an "allergic rxn", sends him home on Benadryl. Bloodwork /UA is negative. All symptoms resolve within one week or so, but then the rash reappears. Pt has no known allergies, takes a few meds chronically but denies taking any new meds.

Что бы ето могло быть? ДоХтора, что скажете?

- allergic reaction to something he doesn't know he is allergic to yet
- viral entity
- autoimmune

I need labs, including his eosinophil count
At this point he probably needs CBC w diff (I would look at eiosinophils especially), LFTs, ESR, CRP and a dermatology referral with a goal of biopsy unless they are confident w/o as to what this can be.

[Ne-Blondinka]

I don't have any more info. Just wanted to see if you could add to my differential. Thanks

[Malishka]

I don't have any more info. Just wanted to see if you could add to my differential. Thanks

U need more info to expand differential

Is he getting a bx?

[Ne-Blondinka]

U need more info to expand differential

Is he getting a bx?

Don't know. I'm not his doctor

[Donat]

Don't know. I'm not his doctor

are you a resident or a student?
we need to know more about this guy, this is a professional interest.

[Malishka]

Don't know. I'm not his doctor

Let us know once u know

[Шмоль]

Пациент женщина или мужчина? Если женщина, может такое быть, что она ходит на мани-педи, ей там ручки-ножки мажут каким-то кремом. Вот и реакция только там где мажут и по этому ит камз энд гоуз в зависимости от частоты посещения салона? Wild guess, не бейте больно, но это первое, что пришло в голову.

[Ne-Blondinka]

Пациент женщина или мужчина? Если женщина, может такое быть, что она ходит на мани-педи, ей там ручки-ножки мажут каким-то кремом. Вот и реакция только там где мажут и по этому ит камз энд гоуз в зависимости от частоты посещения салона? Щилд гуесс, не бейте больно, но это первое, что пришло в голову.

Бить не будем Но ето мужчина и вроде без маникюра.