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What is your diagnosis?

Dr Richard Hunt
University of South Carolina School of Medicine

The patient first noticed signs of itching in his scalp and behind his ears when he woke up in the morning; by the afternoon it had begun to spread over his arms and torso and by the evening it had spread all over his body. The itching became more and more intense as time went on, resulting in inability to sleep.

The patient tried several home remedies to stop the itching. He soaked in a tub with the Aveeno Oatmeal solution; he also applied Kalamine lotion and he took benedryl.

Since none of these had any effect, he was taken to the emergency room on two separate occasions to see if there was anything else that could be done.

He was monitored closely for seven hours on the first trip to the hospital and was given higher doses of benedryl and prednisone, as well as ranitidine, a histamine H2 blocker. He was then allowed to go home. By the evening and during the next day, he became worse resulting in another hospital visit.

He was treated with higher doses of benedryl and prednisone for several hours and was evaluated for Stevens-Johnson Syndrome*. After that was ruled out, the patient took benedryl for approximately five more days and prednisone for three days.

It took roughly three weeks for the rash and itching to completely subside. After it subsided, his skin became very dry and flaky for several days.

What caused the rash?


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* Stevens-Johnson Syndrome (also known as erythema multiforme major) is a rare (less than 20 cases per year in the United States) skin disorder that results in rashes and peeling of the skin. It is considered a medical emergency and can result from medication or viral infection (herpes, HIV, hepatitis, viral pneumonia). Complications include sepsis and organ damage. Scarring of the conjunctiva can lead to blindness


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