Case report: A sad rash

With tears in her eyes, an 88-year-old woman, accompanied by her daughter who drove, presented a rash (and more) to our walk-in clinic the other day. The picture shows the obvious problem—but only hints at the grief felt by the patient. Medically, the patient had a fairly extensive history. Currently in good health, she reported hypertension and a remote cardiac arrhythmia still being treated. She had no known allergies, but was taking several medication: including Synthroid, Lipitor, Indapamide, Coversyl, Celexa and Eliquis. She recalled having rather marked swelling at the site of a wasp sting some 10 or 15 years previously. Two days before seeking medical advice, while gardening, the patient felt a sudden severe sharp pain in her left fourth finger—and knew she had been stung by a wasp. Elevation, ice packs and the ubiquitous Polysporin provided no relief from progressive swelling. She could not remove her ring and tearfully asked if I could remove it. The ring had not been taken off her finger for over 60 years. READ: Case report: After a fight? The rash—or skin and tissue damage—was painful, itchy and inflamed. The locally edematous finger was accompanied by distal and proximal erythema—starting to progress up her forearm. The visit was on the Sunday of a holiday weekend, but we were able to locate a jewelry store in a nearby mall which miraculously was open and had a delicate ring cutter. I knew the store—having had a ring removed from my finger years ago—following a basketball injury to the proximal interphalangeal joint. To avoid a prolonged wait at an emergency department, we contacted the store and sent the patient off to have her ring removed. She was assured that after her finger healed, the ring could be restored and replaced. Elevation, cold packs and an antihistamine were recommended—with explicit advice to report or return if the finger and arm did not improve rapidly once the ring was removed. A not uncommon scenario, with reaction to a wasp sting—but rarely accompanied by such emotional stress. Perhaps we should invest in a ring cutter—but then we would probably never have occasion to use it. I wonder if many offices or clinics have a ring cutter? Robert Dickson is a family physician in Hamilton. This report is based on a real case from Dr. Dickson’s files.

Case report: A sad rash

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