Dermatologic Emergencies

Diagnosing And Managing Life-Threatening Rashes

Nguyen, Thomas MD
Freedman, Jessica MD
Burke, Marianne C. MD
Playe, Stephen J. MD, FACEP

Authors
Thomas Nguyen, MD Assistant Professor of Emergency Medicine, Mount Sinai School of Medicine, New York, NY.
Jessica Freedman, MD Assistant Professor of Emergency Medicine, Associate Residency Director and Mount Sinai Residency Site Director, Mount Sinai School of Medicine, New York, NY.
Peer Reviewers
Marianne C. Burke, MD Consultant, Burke Emergency Medicine Consultants, Glendale, CA.
Stephen J. Playe, MD, FACEP Assistant Professor, Emergency Medicine, Tufts University School of Medicine; Residency Program Director, Department of Emergency Medicine, Baystate Medical Center, Western Campus of Tufts University School of Medicine, Springfield, MA.

Emergency Medicine Practice 4(9):p 1-27, September 2002.

March 15, 2001: You see a patient for “fatigue.” This 52-year-old man was recently discharged from the hospital on ticlopidine and methyldopa. When you enter the room, he is fully clothed in a suit and tie—another violation of the ED's “get naked” policy (which is more honored in breach than observance). He looks okay—he's certainly well-dressed, and through his coat, his lungs sound clear. Looks like another “viral syndrome.”

February 25, 2002: You receive an ominous-looking certified letter. The complaint is lengthy but you understand the gist. A patient you had seen almost a year ago died two days after his visit from an intracerebral bleed. The plaintiff's lawyers cite a triage note that documented complaints of “fatigue and rash”; your record did not mention a rash. The attached pathology report listed the cause of death as “medication-induced TTP.”