Infectious Disease

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A 31-year-old man was treated for otitis media after presenting to the ED with severe ear fullness, pain, and diminished hearing on one side. Despite antibiotic treatment, the symptoms worsened after 72 hours. his symptoms worsened. Tender, vesicular erythematous lesions developed in his mouth and exclusively on the left side of his face, including his forehead, maxilla, and mandible

This nodule on the neck is a typical location and appearance for an epidermal cyst. If the cyst has never been inflamed or infected, it may be removable through a very small punch biopsy followed by lateral pressure or a small linear incision.

Images: oral hairy leukoplakia, oroesophageal candidiasis, disseminated cryptococcosis, Stevens-Johnson syndrome, eosinophilic pustular folliculitis, prurigo nodularis.

Ramsay Hunt syndrome is a peripheral facial neuropathy that causes unilateral lower motor neuron pattern facial weakness. It is associated with a painful erythematous vesicular rash of the ear or nearby areas and/or oropharynx.

This solitary, very pruritic, annular lesion suggests dermatophytosis. KOH preparation verified the presence of Tinea faciei. This infection is usually associated with contact with a new kitten or puppy.

This clustered grouping of small, shallow erosions surmounting a slightly indurated plaque is characteristic for “cold sores.” Because no vesicles were present and the lesions appeared to be crusting over, the patient was advised to apply an OTC cream (docosanol 10%) per package insert instructions.

Guttate psoriasis often appears in conjunction with an upper respiratory infection, particularly streptococcal tonsillitis, as it did in this patient. This phenomenon is more common in children.