Vesicular rash anyone? New case time...

[VictoriaO]

Hello, sorry for the delay in posting the rest of this case, our house staff was graduating the past week, thus I was busy (working up a new onset non-ischemic dilated CHF with fevers! cool ID stuff)

 

Anyways, so good job PA student, we were worried about tumor lysis syndrome prior to administration of IV steroids. We did a full lymph exam and a chest/abdomen/pelvis CT scan and a blood slide to look for malignancy, as this can be precursor in up to 20% of cases of onset of Sweet's syndrome. This was negative for any obvious malignancy (though pt had some thyroid nodules and a whopping big gallstone). She looked much better after just 24 hours of steroids, blisters went down, her face was much clearer.

 

She ended up telling us she had a history of ulcerative colitis, it just hadn't been acting up the past year so she "didn't think it was relevant". There are about 40-some cases of Sweet's syndrome in patients with UC, more in pt's with Crohn's it seems. She was pretty reluctant to see her GI specialist after this, she was having trouble understanding how the two events could be related, though she became more and more reasonable after multiple steroid doses. Also per other outside records that showed up had a history of alcoholic pancreatitis. Again, squirrelly historian, so that always makes things tough. But ended up being a really interesting case!

 

Thanks for participating, I'll share another case soon if I get a good one. I'm constantly on safari hunting zebras (which are common at my hospital) so I'm sure it's only a matter of time.

[VictoriaO]

Hello, sorry for the delay in posting the rest of this case, our house staff was graduating the past week, thus I was busy (working up a new onset non-ischemic dilated CHF with fevers! cool ID stuff)

 

Anyways, so good job PA student, we were worried about tumor lysis syndrome prior to administration of IV steroids. We did a full lymph exam and a chest/abdomen/pelvis CT scan and a blood slide to look for malignancy, as this can be precursor in up to 20% of cases of onset of Sweet's syndrome. This was negative for any obvious malignancy (though pt had some thyroid nodules and a whopping big gallstone). She looked much better after just 24 hours of steroids, blisters went down, her face was much clearer.

 

She ended up telling us she had a history of ulcerative colitis, it just hadn't been acting up the past year so she "didn't think it was relevant". There are about 40-some cases of Sweet's syndrome in patients with UC, more in pt's with Crohn's it seems. She was pretty reluctant to see her GI specialist after this, she was having trouble understanding how the two events could be related, though she became more and more reasonable after multiple steroid doses. Also per other outside records that showed up had a history of alcoholic pancreatitis. Again, squirrelly historian, so that always makes things tough. But ended up being a really interesting case!

 

Thanks for participating, I'll share another case soon if I get a good one. I'm constantly on safari hunting zebras (which are common at my hospital) so I'm sure it's only a matter of time.

[VictoriaO]

Hello, sorry for the delay in posting the rest of this case, our house staff was graduating the past week, thus I was busy (working up a new onset non-ischemic dilated CHF with fevers! cool ID stuff)

 

Anyways, so good job PA student, we were worried about tumor lysis syndrome prior to administration of IV steroids. We did a full lymph exam and a chest/abdomen/pelvis CT scan and a blood slide to look for malignancy, as this can be precursor in up to 20% of cases of onset of Sweet's syndrome. This was negative for any obvious malignancy (though pt had some thyroid nodules and a whopping big gallstone). She looked much better after just 24 hours of steroids, blisters went down, her face was much clearer.

 

She ended up telling us she had a history of ulcerative colitis, it just hadn't been acting up the past year so she "didn't think it was relevant". There are about 40-some cases of Sweet's syndrome in patients with UC, more in pt's with Crohn's it seems. She was pretty reluctant to see her GI specialist after this, she was having trouble understanding how the two events could be related, though she became more and more reasonable after multiple steroid doses. Also per other outside records that showed up had a history of alcoholic pancreatitis. Again, squirrelly historian, so that always makes things tough. But ended up being a really interesting case!

 

Thanks for participating, I'll share another case soon if I get a good one. I'm constantly on safari hunting zebras (which are common at my hospital) so I'm sure it's only a matter of time.