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Consultant Vol 44 No 10

A painful rash suddenly developed on the chest wall of an otherwise healthy 8-year-old girl. Examination of the rash revealed grouped vesicles with an erythematous base in a linear distribution along the T5 dermatome. The child had not been vaccinated with varicella vaccine and had had chickenpox 3 years earlier.

A 65-year-old woman sought evaluation of a unilateral, asymptomatic rash that involved the oral mucosa and lips. The rash consisted of ulcerations and vesicles. The suspected diagnosis of herpes zoster was confirmed 4 days later when the patient experienced lancinating pain throughout the affected area and into her scalp and neck.

When vesicles developed on a 35-year-old man’s right sole, he thought he was
having a recurrence of "athlete’s foot." However, pain and tenderness in the
area suggested herpes zoster. Indeed, the vesicles and erosions shown are
mainly in the S1 dermatome.

For 3 days, a 44-year-old man had several crops of tiny vesicles with raised erythematous bases on the right side of his neck and 2 elongated maculopapular lesions at the base of the neck. All of the lesions were within the C3 dermatome.

35-year-old Hispanic man presented with nonproductive cough; dyspnea; fever; and a painful, ulcerated, 1.5-cm, red-brown plaque on the left flank. He had had the lesion for 3 months and the symptoms for 1 week. The patient had grown up in Arizona, and he traveled there 4 months before the lesion arose.

A 53-year-old man with type 2 diabetes mellitus and hypertension presented to the emergency department with pain in his left upper chest and back, neck, and shoulder. The pain increased with passive and active range of motion testing and decreased at rest. His physical examination was unremarkable except for restricted left shoulder movement and generalized tenderness in the left shoulder area.

For 3 years, numerous skin-colored papules had been present on the face of a 59-year-old man. The lesions developed several months after renal transplantation and the start of immunosuppressive therapy.

For a few days, this 73-year-old woman had had an itchy, painful rash on the right side of her face. Despite its proximity to her eye, she had no ocular involvement and no blurring of vision.

A 37-year-old man presents for evaluation
of 3 reddish, tender, 2-cm, elevated
lesions on his right ankle that have
failed to respond to oral amoxicillin/
clavulanate prescribed by another
physician. The lesions have been
present for 8 weeks. Each lesion has a
central opening and watery yellow drainage (Figure 1). The patient recently
returned from a trip to Central
America, where he had sustained multiple
mosquito bites.

Two weeks earlier, this 66-year-old man had been hospitalized because of leftsided chest pain. However, cardiac evaluation revealed no abnormalities.

Since adolescence, a 67-year old woman had had multiple nodular lesions on her body that were painful at times, particularly when pressure was applied. She reported that other family members, including her mother and brother, had similar lesions.

A 23-year-old woman presents with severe right knee
pain that resulted from a collision with another player
during a soccer game. The majority of the force of the
blow was to the right knee. The medical history is noncontributory.

We have recently had an upsurge in children with type 1 diabetes at our gastroenterology
clinic for celiac screening.


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