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Peculiar Rash Diagnosis Cracked by Oregon FNP Embracing Technology

























Elaine Hanks got the spark to work in nursing back in 1975, and she's been a nurse ever since. At the age of 60, she fulfilled her lifelong dream of becoming a family nurse practitioner. Her approach to patient care includes an embrace of technology - something more typically associated with millennials. But then again, Elaine has always followed her own path. It was in that spirit that Elaine cracked a particularly peculiar rash diagnosis for one of her patients at Willamette Family Medical Center in Salem, Oregon.

A 68-year-old man came into Willamette Family Medicine Center with an itchy, red rash on his arms and legs. He did not speak English but said through an interpreter that the rash was spreading. He was taking Warfarin 5 mg every day for atrial fibrillation. When he scratched the rash, it would turn purple. Elaine described the rash as smooth and papular. His legs looked like they had long scratches, but he said he hadn't scratched his legs; rather, that's what the rash looked like when he first noticed it.

After determining there had been no changes in the patient's personal hygiene routine that could cause a reaction like this (eg, use of a different soap, detergent, or lotion, or wearing new clothes), Elaine was stumped. She entered his symptoms into VisualDx and came up with atopic dermatitis and Shiitake dermatitis.

"Since anything is possible, I asked him if he had eaten anything different for him in the last week, maybe out with friends for food at someone's home. He replied, to my amazement, 'Yes,'" He had received some Shiitake mushrooms from a friend who told him that they were good for hypertension. He had put some raw on a salad 5 days previous.

Elaine double-checked his chart; he'd been immunized against herpes zoster, and Elaine observed that the rash was not along dermatomes. Shiitake dermatitis, however, fit the bill: it occurs from eating undercooked Shiitake mushrooms!

Elaine prescribed triamcinolone cream 0.1% and a diphenhydramine anti-itch roll-on to allay the possibility of a secondary infection from scratching or continued petechiae from the Warfarin.

When dermatologist Dr. Art Papier, CEO of VisualDx, heard Elaine's story, he was impressed: "I have been practicing dermatology for 25 years and only read about this diagnosis. I have never seen it personally. It is a remarkable story."

Elaine's approach to patient care is simple yet personal. "I like to find out people's stories, discover their resiliencies, and use that to help them heal." Her caring nature and investigative spirit helped this patient, in particular, recover and learn.

About VisualDx

VisualDx is an award-winning diagnostic clinical decision support system that has become the standard electronic resource at more than half of U.S. medical schools and more than 1,500 hospitals and institutions nationwide.  VisualDx combines clinical search with the world's best medical image library, plus medical knowledge from experts to help with diagnosis, treatment, self-education, and patient communication. Expanding to provide diagnostic decision support across General Medicine, the new VisualDx brings increased speed and accuracy to the art of diagnosis. Learn more at