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By Lawrence A. Schiffman, DO, and Stephen
M. Schleicher, MD
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CASE:
A 45-year-old woman presents with a widespread, itchy, red
rash on her trunk, neck, and extremities that began approximately
two days ago. She denies any history of a similar condition,
as well as any swelling of the lips or difficulty breathing.
Her family physician recently prescribed a thiazide diuretic
for hypertension and mild leg edema. Examination reveals
a diffuse, erythematous, urticarial eruption involving more
than 50% of her skin surface.
WHAT IS YOUR DIAGNOSIS?
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This patient’s history and clinical presentation are
classic for a drug hypersensitivity reaction. Antibiotics (most
notably amoxicillin) and diuretics are common causative agents.
A reaction to medication should be suspected in any patient
who develops a morbilliform or urticarial skin rash. A detailed
medical history and complete list of medications are of utmost
importance in establishing causality. Immediate cessation of
the offending agent usually results in prompt clearing. Oral
antihistamines and topical steroids may hasten resolution.
More severe cases may warrant a short course of oral prednisone. |
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Dr. Schiffman is a dermatology resident
at St. John's Episcopal Hospital in Far Rockaway, New York.
Dr. Schleicher is director of DermDx Centers and a clinical
instructor
of
dermatology
at
the Philadelphia
College of
Osteopathic Medicine, at Kings College in Wilkes-Barre, Pennsylvania,
and at Arcadia University in Glenside, Pennsylvania. He is
also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 38(5):33-4, 2006
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