Dermatologic emergencies.

(IM.32) A 65-year-old female is evaluated by her primary hospital team for the evaluation of a new rash. Approximately 1 week ago she was admitted for an exacerbation of chronic bronchitis and given trimethoprim/sulfamethoxazole (Bactrim). While her respiratory symptoms have improved, two days ago she developed a low-grade fever, a headache, and her eyes became red. Today she has a red rash on her face and chest. Additionally, she has numerous ulcers on her lips that were not there yesterday. On exam, she has scattered, irregularly shaped, dusky macules on her trunk and face - some are targetoid in nature. She also has mucosal involvement, with erosions and ulcers on her lips, inside her mouth, and around her eyes. What is the most likely diagnosis?

(M3.DM.16.69) A 32-year-old man presents to the emergency department complaining of excruciating pain of his left calf. He states that he was bitten by a spider three days ago; however, yesterday his calf became swollen, red, and extremely painful. His vital signs are: T 102.8 F, HR 112 bpm, and BP 134/76. On exam, his distal left leg is swollen, extremely tender to palpation, and appears purples and dusky. You note crepitus is present. A biopsy is performed and the results are shown in Figure A. What is the most likely diagnosis?

(M3.DM.16.36) A 40-year-old woman with a history of alcoholism presents to the emergency department complaining of extreme pain in her left leg for the past four days after falling while drunk. Vital signs are T 103.1 F, HR 115 bpm, and BP 108/74. An image of the leg is shown in Figure A. Apart from the findings on Figure A, exam is positive for severe tenderness of the left thigh and crepitus. Apart from IV fluids, what other treatment should this patient receive?

(M3.DM.16.34) A 53-year-old man with type 2 diabetes mellitus presents to the emergency department complaining of the worst pain he has ever experienced in his right leg. He states that two days ago he cut his calf while working on the lawn. This morning he noticed a slight discoloration of his right calf. He says that although his leg does not look that bad, the pain is excruciating. Vital signs are as follows: T 102.5 F, HR 102 bpm, and BP 124/82. Physical exam reveals a slightly erythematous and swollen distal right calf that is extremely tender to palpation. A photo of the leg is shown in Figure A. What is the most common causative agent for this condition?

(M2.ID.15.4678) A 22-year-old female is hospitalized with fever and hypotension refractory to fluid resuscitation. Her vital signs are as follows: T 39.0 C, P 110, BP 86/52, RR 12, SpO2 98%. Physical exam reveals diffuse macular erythroderma (Figure A) and the following findings of the conjunctiva (Figure B) and oral cavity (Figure C). She complains of muscle aches as well as diarrhea for the past 3 days. She denies any recent travel or new sexual partners. She had her last menses 4 days ago and always uses a tampon. What is the most likely organism to cause this patient’s presentation?

(M2.DM.15.73) A 47-year-old female presents to the emergency department in distress with a wound on her right lower leg. The patient describes intense pain over the site yesterday that has since dissipated; she is now insensate and not in pain. She also states that the area has been changing colors from first red to now purple/black. She reports having been stung by a bee near that spot 2 days ago. Her medical history is significant for type II diabetes, which is controlled with glipizide, and chronic headaches, for which she regularly takes naproxen. Her vital signs are as follows: T 38.9 C, HR 109, BP 80/57, RR 22, and SpO2 96%. Physical examination shows a 5cm x 12cm wound over the anterior right lower leg that is discolored purple and black towards the center of the wound with expanding edema and erythema towards the edges (Figure A). The area is insensate to light touch and pin-prick. No crepitus is noted on palpation of the wound. Which of the following is the most likely causative organism in this patient's presentation?