Case 1
A 64 years old Chinese lady who has bilateral knee OA, was admitted two days earlier for an elective left total knee replacement. Previously, she had her surgery postponed once due to some non-specific ECG changes and she was asymptomatic.
On the day of the planned surgery, she complained to the doctor during morning round that she had this slightly pruritic rashes over the shin for more than three weeks. The plan was, surgery immediately cancelled, referal to dermatologist and to get new date in three weeks.
On inspection, there were patches of well-defined erythematous scaly lesions.
Diagnosis?
Tinea corporis (Fungal scrapping positive).
Poor little old lady.
Case 2
This is the second time I am seeing this kind of skin rashes.
65 years old Chinese man, complaint of numerous red spots over his lower limbs and some over the forearms, which were non-pruritic, of three weeks duration. No significant drug or allergy history. He just started working as a guard performing night duties in a guest house.
On inspection, there were multiple red spots with surrounding rim of hypopigmentation (halo-liked) noted mostly over the extensor surfaces of the limbs.
Diagnosis:
Insect bite reaction.
(Clue: Lesions only appeared on the areas not covered by clothing, he wore shorts all the time).
45 years old lady presented with fever of 5 days duration, associated with chills, rigors, nausea, and bodyache. There was history of dengue outbreak in neighborhood. At day 5, fever resolved and the above rashes appeared mostly over her arms.
