A Diagnosis More than Skin Deep

​BY AARON SNYDER, MDInfectious processes, such as streptococcal infections, can partially masquerade as alternative diagnosis. Streptococcal infections are a frequent source of infection treated by emergency physicians, and it is crucial that the appropriate tests, antibiotics, and hospitalization are used to recognize rash patterns and to identify causes and the differential of causation.A 60-year-old woman presented from her primary medical doctor's office with fever, fatigue, tachycardia, and facial discomfort for two days that developed into a malar rash. The patient reported one day of fever, several days of sore throat, and nonproductive cough for several months with new onset pain with swallowing for two days.Malar distribution rash with tenderness on palpation.She had no recent travels, known sick contacts, or recent hospitalizations. Initial vital signs included a temperature of 101.9°F, an irregularly irregular heart rate of 120 bpm, a respiratory rate of 18 bpm, a blood pressure of 148/96 mm Hg, and oxygen saturation of 96% on room air. Her physical exam noted posterior oral pharynx erythema with tonsillar exudates, no ocular involvement, clear tympanic membranes, and clear nasal turbinates. A malar distribution rash was noted with tenderness to palpation, inflamed appearance, and clear, raised demarcated edges as shown in the picture. Cardiac exam noted tachycardia and irregularly irregular heart rate without murmur or gallops. Lungs were clear bilaterally. Neu...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research