1/5. An unusual site of chigger bite in a patient with scrub typhus.A 70-year-old female farmer was admitted to the hospital because of fever, headache, and diarrhea for 7 days. hypotension, right-sided pleural effusion with respiratory distress and leukocytosis were noted. She was initially treated as systemic bacterial infection by i.v. administration of ampicillin/sulbactam and amikacin. Because fever persisted in spite of aggressive treatment, a repeat thorough physical examination was done. An eschar was found over the left-sided labium majus and an enlarged lymph node was noted over the left inguinal region. Under the impression of scrub typhus, minocycline was administered. The patient's clinical condition improved dramatically within 3 days. The diagnosis was later confirmed by a serologic test for rickettsia tsutsugamushi.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/5. Idiopathic palmoplantar eccrine hidradenitis in children.Idiopathic palmoplantar eccrine hidradenitis (IPPH) is a recently described disorder characterized by painful erythematous plantar nodules and in three cases, showed a typical neutrophilic infiltrate around and within the eccrine sweat apparatus. Five cases of IPPH on the soles of the feet in healthy children are reported. The disorder presented after intense physical activity in four cases. The course was benign and self-limiting. Complete bed rest for several days without any medical therapy led to alleviation of the pain and disappearance of all the lesions. Conclusion. Idiopathic palmoplantar eccrine hidradenitis may be more common than reported. Paediatricians should be aware of it in order to avoid unnecessary diagnostic tests and treatments.- - - - - - - - - - ranking = 0.05195688953206keywords = physical (Clic here for more details about this article) |
3/5. A case of fatal biphasic anaphylaxis secondary to multiple stings: adrenalin and/or a longer observation time could have saved the patient?We report the case of an atopic male, 76 years old, with post-myocardial infarction ischaemic cardiopathy, arterial hypertension and a history of insect-sting induced large local reactions who died because of a biphasic anaphylaxis subsequent to multiple Vespid stings (about 15). Within approximately ten minutes after the stings he developed urticaria, extended erythema and hypotension (90/60 mmHg), measured by a family member. The objective physical examination by the emergency doctor at the patient's home revealed an orticarioid reaction and erythema of the back and neck, an unaffected respiratory apparatus and CNS, normal pupils, a pulse rate of 74, normal blood pressure ranging from 120/70 to 130/60 mmHg. The patient was administered antihistamine and corticosteroid through parenteral route. During the 45' observation period at the patient's home the urticaria subsided but not to completion. Approximately 40 minutes after the emergency doctor left, the urticaria reoccurred, angioedema of the neck and worsening asthenia developed. The patient died, despite attempts to resuscitate him by the emergency doctor that had been called out again. A post-mortem examination revealed generalised eodema of the lungs, brain, glottis, and bowels due to the severe characteristic systemic compromise of anaphylaxis. The Authors discuss whether an early use of adrenalin and/or a longer observation time could have saved the patient.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/5. Insect bite-induced hypersensitivity and the SCRATCH principles: a new approach to papular urticaria.Insect bites and the associated hypersensitivity reactions known as papular urticaria account for a significant number of all referrals from pediatricians and dermatologists to our pediatric dermatology clinic. Unfortunately, children affected by these eruptions are frequently misdiagnosed and often subject to expensive evaluations including invasive and unnecessary procedures. Here we review the course of 4 children with the typical physical findings and natural history of these reactions. On the basis of our clinical findings and experience with this patient population, we propose a set of principles (termed "SCRATCH") as clinical features to aid clinicians in making an early and accurate clinical diagnosis. We conclude that a more appropriate term for future study and diagnosis of this entity is insect bite-induced hypersensitivity.- - - - - - - - - - ranking = 0.05195688953206keywords = physical (Clic here for more details about this article) |
5/5. Sting of the puss caterpillar: an unusual cause of acute abdominal pain.We report the case of a 41-year-old man with abdominal pain after envenomization by a puss caterpillar. The patient's medical history and physical examination revealed classic symptoms, leading to the correct diagnosis and appropriate therapy with intravenous calcium gluconate. Although severe, local reactions to puss caterpillar envenomization have been previously described, to our knowledge this is the first report of a patient with severe, acute abdominal pain caused by a puss caterpillar's sting.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |