A 33-Year-Old Man with a Facial Rash 英文参考文献.docVIP

Open access, freely available online Learning Forum A 33-Year-Old Man with a Facial Rash John Fleming,William A. Lynn* D E S C R I P T I O N o f C A S E A ear and spreading into the periorbital region. He was 33-y-old man presented to his primary care practitioner with a rash beginning around the left known to have eczema (atopic dermatitis), and the diagnosis of secondary bacterial infection and periorbital cellulitis was made. Because of a history of penicillin allergy, the patient was started on erythromycin. This treatment had no effect, and the rash extended. On day 4, he presented to the hospital accident and emergency department. He was systemically unwell, complaining of drenching sweats and rigors. On examination he was alert, he was pyrexial at 39.2 °C, his pulse was 100 bpm, and his blood pressure was 128/70 mm Hg. There was a widespread erythematous rash covering his face, chest, and arms, which was described as wet with a yellowish exudate. The rash extended around both eyes, which could not be opened (Figure 1). DOI: 10.1371/journal.pmed.0010017.g001 Figure 1. Appearance of Part of the Face and Shoulder at Presentation to Hospital There are multiple shallow ulcers with copious creamy exudates and some crusting. A few intact vesicles are also visible. The right eye was closed by exudates. The patient had a history of atopic eczema (since childhood), rhinitis, and asthma. He was taking inhaled corticosteroids for asthma and had last received a course of systemic steroids one year previously. There were no risk factors for HIV infection. Citation: Fleming J, Lynn WA (2004) A 33-year-old man with a facial rash. PLoS Med 1(2): e17. Copyright: ? 2004 Fleming and Lynn.This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Which Investigations Were Now Indicated? In many patients w