Case report: On awakening

Sometimes when I enter an examining room at our walk-in clinic, it is not immediately obvious, which of several people is actually the patient (although unfortunately, it is often all of them). Recently, on entering the room, I was greeted by an enthusiastic, energetic, bouncy, happy—obviously well—three-year-old little girl. Seated at the consultation desk, was the child’s distraught, anxious and worried mother—whom I assumed was the patient.Surprisingly, the patient turned out to be the child. Her mother reported that the girl had been perfectly well, with possibly a slight runny nose for two days (an almost universal complaint during this season)—happily attending day care (where no other child was ill—apart from a runny nose). Read: Dr. Robert Dickson: Case report: Is it shingles?The girl had no illnesses, allergies or contact with anyone or anything different. When her mother took off her pajamas that morning, she was shocked and concerned about the widespread rash she found all over her daughter’s trunk and limbs (see picture). The rash was not itchy or sore—and as mentioned, the child was otherwise in good health. Examination revealed the erythematous, slightly raised variegated dramatic rash widely distributed over the patient’s body. I believed that the rash was a result of exposure to a virus at daycare—probably erythema multiforme. Urticaria seemed unlikely. Since the patient was not ill or symptomatic in any way, I suggested observation—predicting resolution within a few days. No treatment seemed necessary. Most of the consultation consisted of explaining my diagnosis and calming her mother. I find that labelling or naming a patient’s problem, with discussion and reassurance when appropriate, is one of the most important aspects of medical care. I believe it helps—even if I am wrong.I wondered if other physicians would agree with the diagnosis—and whether they felt that the child should remain away from others until the rash resolved. I have never seen a “cluster” of cases of erythema multiforme—my only concern being any risk if exposed to someone pregnant.Dr. Robert Dickson is a family physician in Hamilton. This report is based on a real case from Dr. Dickson’s files.

Case report: On awakening

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