This is a 4-year-old female with a chief complaint of 2 days of rash. She appears to be completely unbothered by the rash, and has been afebrile without any recent infections/illnesses; a complete review of systems is negative. The patient has been eating and drinking well and her behavior is at baseline. Her mother at bedside denies any new exposures such as detergent, lotion, and food. She has no significant past medical history and does not take any medications; she is up to date on vaccines and has not received any new vaccines recently. Vital signs are within normal limits for age. The physical exam is significant for diffusely scattered, erythematous “targetoid” lesions along with equally scattered erythematous, slightly raised wheals. This rash is found on her trunk, extremities, and palms…
Read MoreA 33-year-old male presents to the ED with ongoing left lower extremity pain and a few days of malaise. He has a history of bipolar I disorder, as well as chronic alcohol, tobacco and marijuana use. He first presented to his primary care doctor six days ago with erythema and pain over the left medial malleolus. At that time he had no other symptoms and physical exam was otherwise unremarkable. He was treated for presumed cellulitis with doxycycline, which he took at half of the prescribed dose due to a miscommunication with his doctor…
Read MoreA 34-year-old female with medical history notable for varicose veins presents with complaint of left medial thigh pain. The patient states the pain started 3 days ago. She denies any fevers. She states the area is very painful to the touch. No antecedent trauma or injury. She has been taking Tylenol with minimal relief. She has a remote history of varicose vein ablation to her left leg..
Read MoreIn her first visit, a 43-year-old female with no significant past medical history presentS to the emergency department and is found to have lymphadenopathy. Three weeks prior to presentation, she began to notice swelling to her eyelids, worse when she woke up in the morning. One week prior to presentation, she noticed swelling to her right posterior neck and left anterior neck, as well as pain in her jaw when she chewed. The patient denied fevers, chills, congestion, sore throat, trouble breathing or swallowing, or cough. Her exam revealed very faint upper eyelid swelling and right suboccipital and left anterior cervical lymphadenopathy. Laboratory testing, including a CBC and BMP were normal, hCG was not consistent with pregnancy and HIV was nonreactive. The patient was discharged from the ED with PCP follow-up…
Read MoreA three-year-old otherwise healthy male presented with rash. The patient’s mother stated she noticed large, purple/red lesions on the patient’s lower extremities over the last week. They appeared to be itchy but not painful. The patient had URI symptoms a week and a half ago that had since resolved. For the last week he had not had any fever and has been behaving like his normal self. He intermittently stated “his belly hurt” but did not have any vomiting or diarrhea. Last bowel movement was the day prior and looked normal. The patient had no history of bleeding symptoms or family history of bleeding disorders. The patient was up to date on vaccinations. He had not taken or used any new medications, foods, lotions, detergents. Vitals were normal. Exam showed non-blanching lesions along the lower extremities without oral mucosal or genital involvement (Figure 1). There were no lesions on palms/soles. The upper and lower frenulums were intact without any signs of non-accidental trauma (NAT) on full body examination…
Read More