Emergency medicine physician uses VisualDx to make 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