Today,s photo (Case 3) Erythema marginatum Macular lesion , Not painful ,Not itchy , Reddish pink color , Snake like ring with pale center , Rounded or Irregular shape , long lasting rash , begins on the trunk or arms and spread outwards , the rash never starts on the face ,made worse with heat . G/E : Check vital signs for fever , increased pulse rate , signs of heart failure , Search for presence of subcuteanous nodules over extensor surfaces of joints , Examine the joints for arthritis (migratory ,polyarthritis involving large joints ) . Cardiac examination for valvular involvement , notice tachycardia not proportional to the fever , continuous with sleep , persist after control of fever , Check for gallop rhythm (q) What investigations should be done ? (A) Blood examination for CBC , ESR, ASOT, CRP , Pharyngeal swab for sreptococcal antigen . Chest x-ray for cardiomegaly , ECG : sinus tachycardia , YOU may see fixed prolonged PR interval , Echocardiography : to exclude valvular involvement or evidence of pericardial effusion . Discussion : Erythema marginatum is one of the major criteria of rheumatic fever (Arthritis, carditis , subcuteanous nodules , Erythema marginatum , Rheumatic chorea) , It is present in 70% of patients with acute rheumatic fever , it is a highly specific sign of acute rheumatic fever .
Posted on: Sat, 27 Dec 2014 18:24:29 +0000
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