September 2010







History: A 27 y/o African-American female presented to the Emergency Department complaining of a rash on her groin, armpits and elbows that had been present for 5 days.  The patient relates that she had suffered a spider bite 6 days earlier on her right calf.  She saw the spider but did not capture it.  The bite was quite painful and blistered several hours after it occurred.  The next day, the patient developed a rash on her elbows, groin, and axillae that was red and itchy, and rapidly turned into “pus bumps.”  2 days later the patient presented to an outside ED and was given PO antibiotics which did not seem to help, and eventually presented to the Barnes ED.

Past Medical History: Patient is 5 months pregnant, otherwise no significant past medical history.

Medications:  Bactrim and Keflex (prescribed by outside ED), Benadryl, pre-natal vitamins. 

Physical Exam:  Necrotic plaque with hemorrhagic vesicle left calf. (Fig. 1)  Several 1-2mm pustules coalescing on patient’s inner thighs, buttocks, b/l axillae, antecubital fossae. (Figs. 1-4)

Labs:  WBC: 16.3, Hg: 11.7, Plts: 358, Eos: 8.2, Cr: 0.72, BUN: 9, PT/PTT: WNL, LDH: 213, ESR: 26.0



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