Family medicine resident quickly diagnoses perplexing rash
As a third-year family medicine resident, I often encounter confusing or atypical dermatologic conditions on a day-to-day basis. Recently, I admitted a 33-year-old man to the hospital who presented with several days of a diffuse rash and feeling miserable with fatigue, malaise, and sweats. He had scattered annular pink lesions measuring 2-5 cm in diameter over his entire body but sparing the face and hands. They didn’t appear classic for any condition that I could remember off the top of my head. His initial work-up was negative for infectious causes, he had not traveled, and he had no new drugs or exposures that he was aware of. The team was stumped.
I used VisualDx to help develop a differential diagnosis based on the characteristics of the rash. The differential included erythema annulare, tinea corporis, Lyme disease, erythema multiforme, and lupus among several other causes. After more careful history taking, I became increasingly suspicious for early disseminated Lyme disease, as the patient lived in a Lyme-prevalent area and had spent time outside where he could have been exposed to ticks. We initiated antibiotics and ordered confirmatory testing. My attending had also consulted dermatology to help make the diagnosis and determine if a biopsy was necessary. I felt great because the dermatologist and the lab results confirmed my suspicion that this was Lyme disease. Thanks to VisualDx providing me real-time clinical information, I was able to make the proper diagnosis in a timely manner and get the patient on his way to a healthy recovery.
Lincoln Heath, MD, University of Vermont/Fletcher Allen Healthcare
Doctor uses VisualDx image collection to identify acute meningococcemia in a pediatric patient
The South Carolina Department of Health and Environmental Control (SCDHEC) deployed VisualDx throughout all of its 67 health care facilities, clinics, and hospitals.
At Greenville Memorial Hospital, a nurse practitioner treated a 3-year-old boy who was initially triaged to the non-acute side of the emergency department with complaints of a sore throat. He was assessed with a streptococcal infection. At the end of his emergency shift, Dr. William Finn, an emergency medicine physician, came over to review the patients on the non-acute side of the emergency department.
The young patient did not appear ill, but his mother mentioned he had recently developed skin lesions. After Dr. Finn examined the lesions, he turned to VisualDx to search for images consistent with streptococcal-induced rash. The images he found did not match his direct observations.
Continuing his VisualDx research, Dr. Finn discovered images of meningococcal-related rashes that were consistent with his observations. He immediately ordered blood cultures and began a course of empiric IV antibiotics. The cultures indeed confirmed the diagnosis of acute meningococcemia, and after transfer to the pediatric tertiary hospital, the child fully recovered.
An astute physician, Dr. Finn recounted how the direct comparison of meningococcal and streptococcal images with VisualDx underscored the urgency of the situation and assisted in timely and accurate diagnosis.
Dr. William Finn, Emergency Medicine Physician, Greenville Memorial Hospital
Family medicine student discovers HIV infection
Patient was a young man in his 30s with a 3-day history of general cold/flu symptoms, including sore throat, cough, fever, fatigue, mild diarrhea, nausea, and a headache. The headache was described as retroorbital. No sneezing, rhinorrhea, abdominal pain. There were also signs of swollen cervical lymph nodes. Monospot and throat swab found to be negative. Flu also negative. Patient was a smoker and sexually active. On further probing, patient had recently broken up with a girlfriend and had joined multiple dating apps. He had gone on multiple dates with new women, which usually ended in unprotected sex. VisualDx output Acute Retroviral/HIV Syndrome as the top differential, ahead of mono, influenza, and others. An HIV screen was performed and was positive. Then confirmed with further tests and treatment for HIV was initiated.
J.H., Family Medicine Student
Emergency medicine physician uses VisualDx to support rare diagnosis
I am an emergency physician working in a major metropolitan city in Southwest Texas. Working a busy regional referral hospital, many Texans from surrounding counties come to us as a last-ditch effort for their ailments. Such was the case when an otherwise healthy 26-year-old female came to me with a chief complaint of a chronic rash.
The young woman had been seen by other healthcare providers at least 3 times prior to arriving to our ED for care. Her complaints each time were a painful disseminated rash that had been present for over 3 weeks. She had previously been diagnosed with an allergic reaction, dermatitis, and herpes zoster, with failure to the prescribed treatment to those respective treatments. With increasing pain and a worsening rash, her frustration was growing.
She presented to us tearful, anxious, and with a fever (100.6°F [38.1°C]) and a rash that was papular and hemorrhagic as well as necrotic, primarily on her extremities. The lesions were painful and appeared to be in different stages of development. The remainder of her exam was benign except for a mild tachycardia of 105. As I do on most rashes that are not clearly urticarial or allergic in nature, I turned to VisualDx to help me develop a differential. Using the VisualDx Differential Builder, I was able to develop an appropriate differential which included the rare diagnosis of disseminated gonococcemia.
After multiple hospital visits and misdiagnosis during those visits, the patient initially received a definitive diagnosis and admission for the treatment and management of a life-threatening disease. I am not sure I would have had the rare diagnosis of disseminated gonococcemia on my initial differential diagnosis if it were not for the VisualDx Differential Builder. The ability to develop a broad, symptom-based differential using VisualDx is a prominent tool in my arsenal to take care of patients with a nonspecific rash.
Besides the online version, I have VisualDx on my iPad and iPhone to share images with patients at the bedside in real time. I use VisualDx on almost every shift, and it remains a powerful tool for my colleagues and me.
S.M. MD, Emergency Medicine
Often mistaken for urticaria, a pediatrician diagnoses Kawasaki disease after consulting VisualDx as reference
A 15-month-old infant came in on her third day of illness with a fever. She was coughing a little and had diarrhea, so I was thinking this was just a garden-variety viral illness. What threw me for a loop was her rash. It was generalized confluent over her hands, feet, groin area, and back. It looked very much like hives, which can happen with just such a viral illness. So I sent her home with antihistamines and close follow-up.
The next day she came in again, this time her mom said the rash was worse and her lips were a bit swollen so I threw that into my differential in VisualDx and, low and behold, Kawasaki disease came up. I got some lab work and I told the mom to come back the next day. I’m glad she did because it turned out her sclera were now injected and she had a strawberry tongue and that pretty much clinched the diagnosis. She is now getting her treatment and so far she’s doing well. I credit VisualDx for reminding me to think about this rare disorder in a timely manner. Thank you.
A.D. MD, Pediatrics
Emergency medicine physician narrows differential to Fournier and initiates life-saving treatment
I had a young man with a rash I had not seen before and was concerned for it being Fournier’s gangrene—although he was not septic appearing and was not diabetic. I used the algorithm to help me narrow it down and it turned out to be Fournier’s. We got it very early and saved his life. He became very sick quickly while still in the ER. VisualDx really helped me narrow it down and helped me decide on a treatment course very early on.
R.E., MD, Emergency Medicine
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