The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
A 75-year-old woman with a history of hypertension, Parkinson disease, osteoporosis, and trigeminal neuralgia was admitted to the hospital for evaluation of fever, rash, and skin pain. Her widespread skin eruption started 3 days ago on her chest and spread centrifugally. She also reported a dull headache and that her eyes felt "sore and scratchy."
Her medications included hydrochlorothiazide (25 mg/d), two extended-release capsules (carbidopa [23.75 mg] and levodopa [95 mg]) three times daily, and vitamin D (800 IU daily). She had been started on carbamazepine (100 mg twice daily) for her trigeminal neuralgia 6 weeks ago; this had recently been increased to 200 mg twice daily.
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Cite this: Thomas N. Helm, Stefanos Haddad, Robert E. Kalb. A 75-Year-Old Woman With Fever, Rash, and Skin Pain - Medscape - Jan 30, 2017.