HPI: 20-year-old African American male presenting with malaise, fevers, and a pruritic rash. He woke up the night prior to admission with a bite on his left leg and recollected seeing several spiders around his home. He subsequently developed pain and swelling of the leg with nausea, vomiting, and diarrhea over a few hours. A rash then spread to his entire body and he presented to the emergency room.
Social History: Single, no smoking, alcohol, or drug use. No recent travel.
Family History: reviewed and noncontributory
Medications: Albuterol prn
Vital Signs: BP: 124/64 T: 38.9 Pulse: 107 RR:16 O2: 100% ORA
Physical Exam: He presented with erythroderma. There were multiple 1-2 mm monomorphic pustules noted on the trunk, extremities, genitalia, and cheeks. [Figure 1-3] On the left lower leg an intact bulla was noted surrounded by a thin, necrotic black plaque with a yellow border. [Figure 4] The plaque was tender.
Laboratory Results: WBC:13.7 (high) Hb:15.9 Hct:44.6 Plt:124 (low) Na:135 K:4.3 Cl:99 CO2:24 BUN:11 Cr:1.2 Ca:8.1 (low),TPro:5.8 Alb:3.2 TBili:2.4 AST:26 ALT:25 AlkPhos:64, HIV: nonreactive, LDH:320 (high)
CK: 159 Ferritin:457 (high) CRP:80.8 (high)Blood Cultures x 2 – negative
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