Clinical Case 078: bewildering blisters, vexing vesicles?
OK, is been a while since we did a simple case – too much podcasting lately. This one is a quick spot diagnosis. If you do a bit of Paeds it is not tricky – hover this diagnosis seems to stump even our smartest JMOs when they first venture into Paeds practice (yes, you know who you are Dr Wright).
This is a 6 month old breastfed, thriving girl from a local community. She is otherwise well and has really been OK except for being a bit cranky, and maybe a little off her fluids for 24 hours. She doesn’t look septic or unwell, maybe a bit flushed.
Mum is concerned about a rash – she has a fluid-filled “blister” on her anterior shin – it is filled with a clear serous fluid, maybe a bit red on adjacent skin.
Now, what should be every diagnostic, Osler-like wunderkind Docs next move?
More history? Might help
No – undress the kid and look in every orifice for other signs to fill in the blanks – complete the puzzle. That is how you fit the history to your inner database of syndromes and diagnostic triads etc.
Any spot diagnoses come to mind?
.
OK, as always – first in with the correct diagnosis and the pathophysiological explanation plus a management plan wins the glory of being named Broome Docs Brainiac of the day.
Quick, gotta be fast to win!
Casey
Elisha correctly diagnosed bullous impetigo. It occurs when a strain of staph secretes an epidermolytic exotoxin which splits the layers of skin to form a bulla or big vesicle.
Treatment: topical mupirocin for small areas + oral ABs for multiple, large areas (fluclox or ceph or whatever your local staph doesn’t like)
Remember to cover as they are infectious including for auto -innoculation in little kids. If recurrent they might need Staph eradication therapy
First10EM Journal Club: February 2019
Killer Keeweedoc
Managing Traumatic bleeding: how can we apply the evidence in smaller hospitals?
About The Author
Casey Parker
I am a GP working in Broome, NW of Western Australia. I work as a hospital DMO (District Med Officer) doing Emergency, Anaesthestics, some Obstetrics and a lot of miscellaneous primary care. Also on the web as @broomedocs | + Casey Parker | Contact