A 45-year-old female presents to your office with fever, malaise and facial rash. The symptoms started acutely one day ago, and she took two tablets of ibuprofen to relieve the fever. Her past medical history is insignificant. She works as a clerk at a private office, and is not physically active. She smokes two packs of cigarettes daily, and consumes alcohol occasionally. She denies any recreational drug use. She has no known allergies. She is sexually active in a monogamous relationship with her husband. The rash is shown below. Other physical findings are within normal limits. Which of the following is the most likely cause of this patient's problem?

Question

A 45-year-old female presents to your office with fever, malaise and facial rash.  The symptoms started acutely one day ago, and she took two tablets of ibuprofen to relieve the fever.  Her past medical history is insignificant.  She works as a clerk at a private office, and is not physically active.  She smokes two packs of cigarettes daily, and consumes alcohol occasionally.  She denies any recreational drug use.  She has no known allergies.  She is sexually active in a monogamous relationship with her husband.  The rash is shown below.   Other physical findings are within normal limits.  Which of the following is the most likely cause of this patient's problem?

Quizplus · Accepted Answer

Explanation: The clinical scenario described is highly suggestive of erysipelas, a specific form of cellulitis. Currently, the lower extremities are the most common sites of involvement, but the face is involved in 5 to 20% of patients. The lesion is usually characteristic: it is red, painful, edematous and elevated. A sharp demarcation from the uninvolved skin is usually present, and a butterfly pattern involving the cheeks and the bridge of the nose may be seen. Other characteristic features of erysipelas are an abrupt onset and the presence of systemic symptoms (fever, chills, malaise, etc). Group-A streptococcus is the typical etiologic agent of erysipelas, although sometimes, other beta-hemolytic streptococci are involved. (Choices B and A)Staphylococcus aureus and gram-negative organisms are very rare causes of the disease. (Choice D) An abrupt onset of systemic symptoms, followed by a rash, may suggest meningococcal infection, but the type and distribution of the rash are different, and meningeal signs are commonly present. (Choice E)Vesicular lesions are typical for HSV. Educational Objective: Group-A streptococcus is the typical etiologic agent of erysipelas. Image is reproduced with permission of Dr. Samuel Freire da Silva, M.D.

A 45-Year-Old Female Presents to Your Office with Fever, Malaise