Journey to the Center of the Rash

Doesn’t roll of the tongue quite as well. Maybe 20,000 leagues under the epidermis? The Rash Awakens? Revenge of the Rash? No. It’s not relapsing so that won’t work. Anyways, I got a mystery. What the hell is this rash? I promise, it’s not that kinda rash. 

It starts as small blisters. Bilateral forearms and hands. Not painful but tender, they pop and the liquid is typical blister juice. Not purulent, not green, not smell. I haven’t tasted it so I can’t speak to its bitterness or otherwise. With any wound, they are tender and sensitive, and don’t seem to have any aggravating factors. 

The patient is an otherwise healthy 30 year old male with a history of major depressive episodes, superficial veinous thrombosis, pulmonary blasto 20 odd years ago, urinary frequency, and the ‘rona at least once. BMI of 23.4, active, mostly healthy diet, works in healthcare.

Has every vaccine imaginable including anthrax and four COVID microchips, I mean vaccines. Takes bupropion, fluoxetine, ferrous sulfate, oxybutinin, multi vitamin, and vitamins d and c. Last travel outside of the state was to Wisconsin (lives in Minnesota) in December 2022. Extensive travel from 2015-2021 to Eastern Europe, Middle East, south east Asia, and Western Europe. 

Labs show anemia (chronic, normal for the patient), slightly elevated BUN of 34, 30:1 BUN to creatinine ratio (high protein diet maybe?), everything else is WNL or +/- just a very few percent. 

Clobetasol hasn’t helped much (maybe if he was more compliant. He applies mupirocin ointment and aquaphor on the advice of his dermatology colleagues. Sudden onset of dizziness 10-12 days after rash appeared, lasted for 10-15 minutes with chest tightness and “hammering heart”, he has never had this before. Work up for an MI, though unlikely is negative and he has had no symptoms since. 

The doc who owns and runs the clinic gives a differential of bullous pemphigoid vs bullous impetigo vs porphyria cutanea tarda. The ED PA throws in MRSA but doesn’t think that fits with the blisters. Waiting on the porphyrin serum and urine tests to come back. 

This is me by the way but seriously. Any ideas? Hit me up with what you think or questions. I’m trying to do my own detective work and might as well tap into all the brains out there much smarter than I. Is it the andromeda strain? A rare disease only spread by 1997 Toyota tacomas? Maybe a pancake overdose? Doubtful. Anyways, love y’all and let me know what you think. 

Image of me, no references.



Comments

  1. AnonymousJune 15, 2023 at 12:19 AM

    I’d stick w the dermatologist advice. Interesting, and also sorry it’s happening.

    ReplyDelete
  2. AnonymousJune 15, 2023 at 12:21 AM

    I’m not sure you should correlate rapid heart rate near syncope w it. That sounds like SVT. Has the rash happened more than once?

    ReplyDelete

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