A 16-Year-Old Girl With Full-Body Rash, Dyspnea, and Swelling

Peter Huynh, MD


January 19, 2022

Physical Examination and Workup

Upon physical examination, the patient is a well-nourished, well-developed teen in mild respiratory distress. Her temperature is 98.6oF (37oC), respiratory rate is 30 breaths/min, heart rate is 110 beats/min, and blood pressure is 100/60 mm Hg. Periorbital angioedema and facial erythema are noted. Extraocular eye movements are within normal limits. Her nasal cavity shows normal nasal mucosa, septum, and turbinates bilaterally.

Upon throat examination, no erythema or exudates are present, and the tonsils are normal, without enlargement or inflammation. No neck stridor or jugular venous distension is observed. Auscultation of the lungs reveals bilateral diffuse wheezes. Cardiovascular examination reveals sinus tachycardia, regular rhythm, and an absence of murmurs.

The patient's extremities are warm and well-perfused. No lower-extremity edema, cyanosis, or clubbing is noted. A skin examination reveals diffuse urticaria and generalized warmth (Figure 1).

Figure 1.

She was given epinephrine (0.3 mg intramuscularly), diphenhydramine (50 mg intravenously), and methylprednisolone (125 mg intravenously). She was given nebulized albuterol for wheezing. Her symptoms resolved within 30 minutes.


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