June 2012






History: 78 yo WF presented from an outside hospital with a 10 month history of an itchy diffuse rash and lower extremity edema.  The patient complained of itchy red spots on her arms, legs, chest and hands that had not ever completely resolve.  At times she had blisters on her hands.  She had been treated with Elimite twice for scabies without improvement in her symptoms.  Of note, patient denied other residents at her nursing home complaining of the same itch or rash


Past medical history: chronic kidney disease (stage 3-4), hypertension, diabetes mellitus type 2, chronic diastolic heart failure, coronary heart disease, anemia, hypothyroidism


Medications: Clonzepam, alprazolam PRN for anxiety, xalatan eye drops, Nepafenac eye drops, iron sulfate, levothyroxine, lisinopril, omeprazole, KayCeil, triamcinolone cream BID, ASA 81, Cardizem, Nebivolol, isosorbide dinitrite, fish oil, furosemide, lantus, prasugrel, miralax, mucinex, ambien, prozac, allopurinol


Allergies: none


Physical exam: several excoriated erythematous patches and plaques on her arms, legs, and chest; few vesicles and erosions on finger. Figures 1-4 depict the rash as seen on the first admission day.


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