Rash In Groin Case Study

This patient has athlete’s foot that has transmitted to his hand. This is a fungal infection caused by tineas, a cutaneous mycoses (22).

The patient was referred for a new itchy and tender bilateral groin lesions that the patient says will drain pus. He also has multiple other complaints. He gives a history of being allergic to DOXYCYCLINE. As previously stated, he has tender sites which can drain pus off and on in his groin for years. There is also history of facial acne and scalp acne since his late teens. He took Accutane during his 20s with improvement by history. He flared and repeated Accutane about one year after completing the first course by his history. He is bathing with unscented Dove and uses cocoa butter lotion. He also has a second problem of itching over his back, shoulders, and arms, and legs

BB’s skin presents as pink, warm and dry. No obvious signs or symptoms of abnormal bruising or lesions present however, the patient states that the skin has of late has

hypotensive with a blood pressure of 82/44 mm Hg. His respiratory rate is 28 breaths/min

No scalp lesions. Dry eyes with conjunctival injection. Mild exophthalmos. Dry nasal mucosa. Marked cracking and bleeding of her lips with erosions of the mucosa. She has a large ulceration of the mucosa at the bite margin on the left. She has some scattered ulcerations on her hard and soft palette. She has difficulty opening her mouth because of pain. Tonsils not enlarged. No visible exudate. SKIN: She has some mild ecchymosis on her skin and some erythema, she has some patches but no obvious skin breakdown. She had some fissuring in the buttocks crease. PULMONARY: Clear to precussion and auscultation, bilaterally. CARDIOVASCULAR: No murmurs or gallops noted. ABDOMEN: Soft, non-tender, protuberant, no organomegaly, and positive bowel sounds. NORALOGIC EXAME: Cranial nerves ii – xii are grossly intact, diffuse hyporeflexia. MUSCULAR SKELETAL: Erosive destructive changes in elbows, wrist, and hands consistent with rheumatoid arthritis. Has had bilateral total knee replacements with stovepipe legs and perimalledal pitting edema 1+. I feel no pulse distally in either leg. PHYCIATRIC: Patient is a little anxious about these new symptoms and there significance. We discussed her situation and I offered her psychiatric services, she refused for now.

The working diagnosis is that this patient is suffering from Angioedema as a result of Anaphylaxis and developing Urticaria. Angioedema is the swelling of deep layers of the skin due the accumulation of fluid, symptoms of Angioedema include swelling of the eyes, lips, hands and feet.

PHYSICAL EXAM: Temperature 98.6, Blood pressure 140/90. Pulse 110. Respirations 26. Her lungs are clear, showing mild signs of distress. Heart sounds are normal, irregular rhythm and bradycardia noted. No edema noted in extremities. Patient skin is cool to touch, slightly clammy. EEG shows prolonged QRS wave, with ischemic ST changes and PVCs. Chest radiograph clear.

Jennette is a seven months old female. Three to four weeks ago (unknown) a cat bite Jennette in her face (on the lower part of her cheekbone). Jennette was at a birthday party. It is unknown how the cat bites Jennette in the face. Jennette's mom Kristi did take Jennette to the doctor in Brookhaven or Summit. Kristi took Jennette at 7:45 pm and Kristi did not notify the father (unknown) until 8:00 pm. Jennette also has a bad diaper rash. The diaper rash has Jennette bottom (butt) raw. The diapers rash begin on her butt cheek all the up to her vagina. While bathing Jennette, she will not sit in the tub on her bottom; due to her but being raw. Jennette just cried. Jennette's butt is always red. It appears that Kristi does not change

She reports a history of back pain, ovarian cysts excision, and breast tumor. She denies chest pain, shortness of breath, or palpitations. Patient reports that her immunizations and preventive care are up to

The patient tells me she noticed a rash on her of right side of her rear end approximately two to three days ago. She said she first felt a sensation before the rash started and then noticed that there were some squishy bumps there. She said it is tender if she touches it. If she is not sitting on it or lying on it or touching it is typically not tender. She has been trying not to scratch it. It does not tend to be itchy. She has been applying a diaper rash cream, but she is not sure if it is helpful or not. She says that she has had this in the past. She recalls having her first episode approximately two years ago and since then has in total, including this episode, had approximately four of them. She has not sought treatment for it before, but as this seems to seems to be continuing, she thought she should come in to have it evaluated. She is otherwise feeling perfectly fine. No fevers, chills, or body aches. No nausea, vomiting, or diarrhea. She is eating and drinking normally. She does not have a history of cold sores. She does not have any other unusual skin rashes. She does not have anything similar to this elsewhere on her body. She is currently not sexually active, does not believe that she is at risk for any such illness.

Skin- she has some mild equimosis on her skin and some anathema. She has patches but no obvious skin breakdown. She has no fissuring in the buttocks crease.

The pain does not go distal past the knee. Her physician also noted that Susan has unimpaired reflexes, normal disc-shaped anatomy, an attenuation of the reflex at the knee, and shows no sign of bladder or bowel incontinence. Based on these results and symptoms a final diagnoses can be made.

On examination erythematous scaly excoriated papules were seen over the posterior thighs and the lower gluteal area. These are the areas which come in contact with the toilet seat. No lesions were seen elsewhere. Systemic examination was normal.

The primary diagnosis selected in this patient is cherry angioma, as the clinical presentation and history best supports this diagnosis. The patient presented with a non-painful, non-pruritic papular rash limited to the trunk of the body with no other negative symptoms. A drug eruption could be responsible for a red rash on the patient’s trunk, but the patient denies any use of new medications and the rash is not generalized, pink, and morbilliform, how drug rashes usually are presented (Ball et al., 2015). Pityriasis Rosea meets some of the criteria, but the rash is not itchy, scaly, or in oval patches, and the patient denies any recent illnesses (Dains, Baumann, & Scheibel, 2016). Thrombocytopenic purpura is a contender for a priority