Mr. Kramer is a 78 year old recent widower.   His wife just recently passed away and he felt an irritation under his right arm.  When he got home, he noticed a rash.  He relates this to sweating in a new suit jacket.  He denies other new hygienic products and no new laundering agents.  Since yesterday, he states the rash is beginning to spread.

 

PMedHx: DM 2 (1990)

HTN  (1994)

 

PSurgHx:  Left knee arthroscopy

 

Family Hx:  Father, deceased:  CAD

Mother, deceased: complications from Lupus

Brother, alive 74:  HTN, Lupus

 

Soc Hx:  Retired banker with 3 grown kids

Walks three times a week in a trail behind his house in a nature preserve; walks his dog on walking trails in woods

Never a smoker; rare social ETOH use; no illicit drugs

Watches carbs d/t DM

 

Meds:  Metformin 500mg BID

Lisinopril 10mg QD

ASA  81mg QD

Atorvastatin 10mg QD (started on this 3 weeks ago)

 

Allergies:  PCN

 

ROS:

General:  feels fatigued, associates this to wife’s passing; denies fever or chills; hard to sleep d/t rash

Skin:  rash under right arm; doesn’t itch a lot, but “burns”

Neck: supple; no lymphadenopathy

Lung: clear

CV:  RRR@78; normal S1 and S2; no mrg

Abd: soft, non tender

Skin:  Vesicular rash on erythematous base; linear in appearance; about 8-10 lesions noted

#1 Based on this patient’s case, you believe he has what type of dermatology problem?

 

#2 What other subjective data would be important to inquire about in this patient?

 

 

#3 What diagnostics would you want to do on this patient?

 

#4 What would your treatment plan be for him?