An Interesting Rash

And no, not interesting in the funny-because-it’s-in-a-funny-place but more because it was a bit… inexplicable.

So a few months ago when I was on my acute medicine rotation as part of my ED training, I came across a bizarre presentation. This young-ish (so I admit, I can’t remember his age!) about 40-something year old, came in with a bizarre rash that had been ongoing and worsening for the past 3 days. He noticed a non-blanching pinpoint rash that started on his hands and forearms, and (not that he noticed initially) his lower legs, and then also started sprouting on his chest. It was very petechial looking, yet his platelet counts were within normal limits, and he had no prior bleeding or clotting disorders, and his PT/APTT etc were all normal. Denied any history of drug usage, and was on only one medication, something innocuous like omeprazole, and the rash was not painful or itchy or cause any unpleasant symptoms (Other than the fact that it was there!) There was nothing significant in his history, no contact from any allergens, no history of any atopy or allergy. I sought my consultant’s opinion, she was equally puzzled. It was all quite bizarre, and we were all ready to send him home after much hemming and hawing, with a prescription for a basic antihistamine. I wrote it out and got the nurses to give him a pack to go home with. 15 minutes later, the nurse came to me and said bizarre-rash-guy wanted to have a word. I went in and found, to my further astonishment, that his rash had suddenly disappeared. Like completely. Whatever was causing his symptoms over the past 3 days, had now suddenly, without warning and certainly without any helpful insight from me or any of the rest of the staff, completely and utterly vanished. I literally searched for it all over his skin, taking possibly more time now than when I first examined him. I recalled how I had apologised when he first came in and I admitted we hadn’t figured out what had caused the rash. And now I apologised again and admitted I couldn’t for the life of me figure out how or why it had disappeared. He must have really thought us to be useless and incompetent. But as I pointed out to him, we did end up solving his problem, albeit without any knowledge of how we managed it.

To this day I have no idea what he had, and later on my consultant and I sometimes found ourselves discussing what it could have been for weeks after this patient had left the ward. Unfortunately we had no photographic evidence, only my notes and our memories.

Leave a Reply

Your email address will not be published. Required fields are marked *