Unknown condition resulting in blistering
 

Good afternoon all,

I have a friend who has been laid up in the hospital for a few days now, and they have no idea what has caused this blistering(all on same arm), her symptoms, or how to treat it(from what she's told me). They've ruled out bug bites.

I'm just trying to help a friend with any leads that she could pass onto her physicians. I've attached photos, and her current condition is:

• 104 degree fever that hasn't broken
• Redness all over the body
• Dehydrated
• Chronic headaches/migraines

I really appreciate any help with this. Thank you for reading.

Any new exposures/medicines/supplements/etc?

I will ask, but to be clear, do you mean while she has been admitted, or prior to? Thank you for the reply

Prior to the admission.

Doesn't look like a systemic allergic reaction to me. Looks more like a local reaction to a bite, sting, or contact to an allergen that has become infected and may be going systemic. Suspect Streptococcus. I would imagine the primary care facility will get a culture/sensitivity, thoroughly wash, debride the infection, bandage, and start her on some broad spectrum antibiotic (fluroquinolone like ciprofloxacin) until lab results indicate otherwise.

She's been resting, so no definitive answer on that just yet. Her fiance let me know that her swelling has worsened, fever slightly lower, and has been in multiple antibiotics thusfar. I doubt I'll be privy to the dosages and types of antibiotics however.

She initially suspected a bite, but they have ruled that out somehow. She's on a variety of antibiotics, but the swelling has worsened. They have not given her or her fiancé any answers as of yet.

This is day 3 of her hospital stay.

Three days!! Variety of antibiotics!! Still has a low-grade fever!! Now ya got my attention.

What hospital is this? Did they get a culture & sensitivity to determine bacteria type and sensitivity to antibiotics? I am concerned about an antibiotic resistant strain. I am thinking that someone else may need to be brought in on this one. A local bacterial infection that is refractory to treatment for 3 days bothers me a lot.

Staph and Strep skin infections are certainly is on the differential, as is Stevens Johnson Syndrome, hence my question about new medications and other exposures.

Now I got to go look that one up! Thanks a lot Doc. :D

Oh and on another subject I will be contacting you in a few week regarding GVHD.

Be well.

MRSA

The initial presentation of MRSA is small red bumps that resemble pimples, spider bites, or boils; they may be accompanied by fever and, occasionally, rashes. Within a few days, the bumps become larger and more painful; they eventually open into deep, pus-filled boils About 75 percent of CA-MRSA infections are localized to skin and soft tissue and usually can be treated effectively.

And that is EXACTLY what is #1 on my DDx!

I'm unsure of the tests she's had thus far, and I think she's probably unsure also unfortunately.

She's at Howard County General Hospital (Maryland), which is a branch of Johns Hopkins. If anyone could figure this thing out I'd think it'd be them, but they have me wondering now.

I appreciate the insight, it certainly appears to be the case.

BryanK- She is fortunate that she has you for a patient advocate. Being affiliated with JH then you should be pushing for their infectious disease specialists to weigh in on this ASAP. Don't f' around with this and be an a'hole if you need to. Old Dog is right on this one, I'll bet money on it!

Good luck and be persistent.

Thank you sir. She has in fact seen the IDS, and still no word on a diagnosis. I understand it takes time, I just didn't figure it took that long to nail down.