| Introduction: |
| A 67 year old woman on multiple new drugs developed a disseminated rash. |
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| History: |
| A 65 year old woman with a 3 year history of painful polyneuropathy was admitted to the hospital for treatment of depression and narcotic detoxification. On day 16 of the admission she started on Bentyl to treat colicky abdominal pain. The next day she developed a widespread minimally itchy rash, and the Bentyl was discontinued.
New medications during her hospitalization included oxycodone HCl(Oxycontin), zolpidem tartrate(Ambien), mirtazapine(Remeron), alprazolam(Xanax), furosemide(Lasix), liotrix(Thyrolar), conjugated estrogen(Premarin), psyllium fiber(Perdiem), buproprion HCl(Wellbutrin), clonidine(Catapres-TTS), bismuth(Bismatrol), and acetaminophen(Tylenol). |
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| Clinical
Presentation: |
| Round to oval red scaly plaques from 0.5-2 cm were widely disseminated on the trunk and extremities including her palms and soles. |
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| Pathology: |
| A skin biopsy was obtained from a scaly plaque on the mid abdomen. |
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| Question
1: |
| What's the differential diagnosis? |
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| Question
2: |
| Which of her medications could be responsible for the rash? |
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| Question
3: |
| What would you recommend? |
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