Chinese
English
German
French
Italian
Spanish
Portuguese
Lithuanian
简单病例
Case 64
A patient is referred by his family doctor who suspects a facial bacterial infection.
History
Have you already been treated for this?
I have been using a cortisone cream daily.
Knowledge of therapeutic attempts is important in understanding the condition of the skin.
Have you ever had any skin problems?
I have had atopic dermatitis since I was a little kid. I almost always have a rash somewhere, usually on the neck or face. Even now, the skin on my neck is dry and cracked.
The history often provides the answer, even for dermatologic patients.
Do you have fever?
I haven't checked, but I think so; I feel warm and bad.
Additional signs and symptoms help refine the differential diagnostic considerations.
How did this problem start?
Two days ago I had a few blisters on the left cheek and then all of a sudden my whole face was covered with sores.
The course of the disease also helps with the differential diagnosis.
Do you have pets?
No, the doctors never allowed me to have any, because of all my allergies.
Always important to know about pets, both because of allergic and infectious diseases, but not helpful here.
How long have you lived in Switzerland?
I was born here, why do you ask?
In the real world, the patient's perfect Swiss accent and flawless grammar would tell you he was not a tourist. But natives can also introduce tropical disease after a vacation.
Are the skin lesions painful?
Not really; the skin is tight, but that's often the case.
Additional signs and symptoms help refine the differential diagnostic considerations.
Do you have any other complaints?
I have a headache and feel bad all over
Additional signs and symptoms help refine the differential diagnostic considerations.
Lesion
Choose the right efflorescences:
Many vesicles (tiny blisters) can be seen, although it is harder on the background of dark skin.
Crusts are present on the right cheek.
No scars are seen; the process is acute.
Look again.
诊断
Choose the right diagnosis:
Impetigo has sharply defined crusts, often honey-colored. Blisters are possible, but not so many diffusely distributed vesicles.
Zoster is dermatomal, while varicella is generalized.
Tinea faciei can be crusted with bacterial secondary infection, but is rarely so vesicular.
The most likely choice, considering the history and physical examination.
The patient does have atopic dermatitis, but this is not the acute illness which brings him to you.
Therapy
Choose the right therapy(ies):
Systemic antiviral therapy is needed; most patients are admitted
Even if bacterial secondary infection is present, attention must be first given to the underlying viral disease.
Indicated for influenza virus infections.
Indicated for cytomegalovirus infections.
Systemic corticosteroids are not indicated for most infectious diseases, as the immunosuppression often leads to a more aggressive course for the infection.
