A wrestler’s pimples
I received this very interesting case in my email today from Medscape CME. I would like to share the interesting article here.
It regards a puzzling facial rash on a 17-year-old boy which did not respond to 2 courses of antibiotics.
You can access the article here: A puzzling facial rash
Wed, 121108 @ 1356
Categories: Medical
Of course it will not improve with antibiotics, cause it’s due to a strain of herpes virus. Its most likely herpes gladiatorum if not mistaken.
LOLz!!! Good one there, palmdoc
Interesting rash. I suppose the modern warrior’s (gladiator/wrestler) cry should be
“We who are about to catch herpes salute you!
mac, the lesions are bilateral on the face and do not follow any dermatomal pattern.
maybe wrestler’s herpes? seems to be following the Vth derrmatome (not sure since it’s one-sided pic)
maybe demodecosis?
Thanks dytia.
medscape server is up now.
Just in case anyone cannot access the link I copy and paste the article here
A 17-year-old male high school student presents to the pediatric infectious disease clinic complaining of a 10-day history of a facial rash that “won’t get better.” The patient had previously visited his primary care provider (PCP), who started the patient on amoxicillin-clavulanic acid 8 days ago. The rash did not improve on the antibiotic, and as a result, it was discontinued and the patient switched to trimethoprim-sulfamethoxazole. No improvement was noted with the second round of antibiotic therapy; the rash continued to spread, and the lesions increased in number. The patient was subsequently advised to follow up with the infectious disease clinic.
At the infectious disease clinic, the patient states that the rash started with several pimples over the forehead and cheek and then continued to spread and involve most of the right side of his face. The lesions are not itchy, but they are painful. The patient has no known drug allergies. His immunizations are up to date. He is very active on the wrestling team and was happily preparing for an upcoming competition. The patient denies having any weight loss, headaches, dizziness, photophobia, fever, or chills. The family history is non-contributory.
On physical examination, the patient is alert and orientated. His oral temperature is 97.0°F (36.1°C). The patient has normal heart sounds, his pulse has a regular rhythm of 97 bpm, and his blood pressure is 125/75 mm Hg. His lungs are clear, and his respiratory rate is 12 breaths/min. The examination of the head, eyes, ears, and nose is remarkable for multiple vesicular lesions measuring about 0.5 cm in diameter (see Figures 1 and 2). There is bilateral submandibular lymph gland enlargement measuring 1.5 cm by 1 cm. The neck is supple. His abdomen is soft and nontender to deep palpation in the epigastric region, and no organomegaly is noted. A complete blood count (CBC) taken at the PCP’s office showed a white blood cell (WBC) count of 7.4 × 103/µL (7.4 × 109/L), with a normal differential; a hemoglobin of 13.6 g/dl (136 g/L); a hematocrit of 38.3% (0.3830); and a platelet count of 298 × 103/µL (298 × 109/L).
Questions answered incorrectly will be highlighted.
What is the most likely diagnosis?
Hint: The patient was disqualified from wrestling because of his lesions.
I’ll post the rest of it later
Brie, thanks for highlighting it. I also found the link to be not working anymore. I wonder why. Maybe try a little later. Their server could be down.
hm… the link doesn’t seem to be working…