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Old 08-23-2017, 15:16   #16
Old Dog New Trick
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Just a hunch. WAG

She work in healthcare, hospice or recently work out at a gym?
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Old 08-23-2017, 16:02   #17
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Thank you sir. She has in fact seen the IDS, and still no word on a diagnosis. I understand it takes time, I just didn't figure it took that long to nail down.
There is a big difference between being at an academic center-affiliated hospital and being at said academic center.

Cultures do take time to grow, but draining/scraping of one of the bullae (large blisters) as shown in your picture should help with the diagnosis.

Staph or strep skin infection and subsequent exotoxin effects could certainly lead to her clinical picture and is more likely than SJS (Stevens-Johnson), but I had assumed (mea culpa!) the docs are working her up for the more common things and you were asking because the process has progressed despite a few days of assessments and intervention which would make for a need to think outside the box.
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Old 08-23-2017, 16:04   #18
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Originally Posted by Old Dog New Trick View Post
Just a hunch. WAG

She work in healthcare, hospice or recently work out at a gym?
That thought process for risk of MRSA is outdated - a large portion of the community at large is colonized with MRSA now, so one does not need any of those risk factors in order to be at risk for MRSA infection.
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Old 08-23-2017, 18:09   #19
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That thought process for risk of MRSA is outdated - a large portion of the community at large is colonized with MRSA now, so one does not need any of those risk factors in order to be at risk for MRSA infection.
Thanks for posting that, I was going to make the same point. CA-MRSA is now endemic.
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Old 08-23-2017, 18:13   #20
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Originally Posted by PedOncoDoc View Post
There is a big difference between being at an academic center-affiliated hospital and being at said academic center.

Cultures do take time to grow, but draining/scraping of one of the bullae (large blisters) as shown in your picture should help with the diagnosis.

Staph or strep skin infection and subsequent exotoxin effects could certainly lead to her clinical picture and is more likely than SJS (Stevens-Johnson), but I had assumed (mea culpa!) the docs are working her up for the more common things and you were asking because the process has progressed despite a few days of assessments and intervention which would make for a need to think outside the box.
Excellent points Doc! Unfortunately, finding someone that can think outside the box is becoming an endangered species. But on the bright side, at lease she is not in a VA hospital.
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Old 08-23-2017, 18:18   #21
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That thought process for risk of MRSA is outdated - a large portion of the community at large is colonized with MRSA now, so one does not need any of those risk factors in order to be at risk for MRSA infection.
I realize that but if those factors are present (e.g., gym) then a place may be identified for follow up notification.

Yep, MRSA and MSSA are now like getting chlamydia from a whore house, all's you have to do is walk in the door.

Whatever this lady has I hope the hospital identifies it and begins the proper treatment.
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Old 08-24-2017, 07:19   #22
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Yep, MRSA and MSSA are now like getting chlamydia from a whore house, all's you have to do is walk in the door.
Will just have to take your word on that one.

Any additional follow up now that a day has passed?
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Old 08-24-2017, 09:26   #23
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I haven't heard from her or her fiancé today, but it's still kind of early. As of my last post, no new news regarding what this is. I will update as soon as I know something.

Thank you for the assistance gentlemen, I really appreciate it.
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Old 08-24-2017, 10:03   #24
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I haven't heard from her or her fiancé today, but it's still kind of early. As of my last post, no new news regarding what this is. I will update as soon as I know something.

Thank you for the assistance gentlemen, I really appreciate it.
So long as she is not clinically deteriorating, some times a bit of watchful waiting provides clarity.
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Old 08-25-2017, 03:37   #25
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They reversed their decision regarding whether the initial cause was a bite of some sort. The final verdict is cellulitis caused by tampering with the bite site(unknown critter). It seems they have found the right antibiotic, and she's been fever-free for almost 24 hours. Is it normal to rule out a bug bite, then reverse that decision 4 days later?

Regardless, I'm just glad she's on the other side of this now. Over 3 days with a fever orbiting at 104 without relief has to take a toll on the body. Thank you for your concerns and assistance, and hopefully this thread can be used for future situations like this.
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Old 08-25-2017, 04:32   #26
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Fantastic, good news this morning.

Reversing course is only a part of "practicing medicine."
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Old 08-25-2017, 07:15   #27
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Originally Posted by BryanK View Post
They reversed their decision regarding whether the initial cause was a bite of some sort. The final verdict is cellulitis caused by tampering with the bite site(unknown critter). It seems they have found the right antibiotic, and she's been fever-free for almost 24 hours. Is it normal to rule out a bug bite, then reverse that decision 4 days later?

Regardless, I'm just glad she's on the other side of this now. Over 3 days with a fever orbiting at 104 without relief has to take a toll on the body. Thank you for your concerns and assistance, and hopefully this thread can be used for future situations like this.
Glad things are getting better. It doesn't have to be an insect bite - any injury to the skin can be a potential site of infection, and can be difficult to attribute the potential opportunity for infection in hindsight.
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Old 08-25-2017, 13:36   #28
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Glad to hear what is potentially a good outcome!
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Old 08-27-2017, 09:17   #29
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That looks like a condition my son suffered from when he was a toddler. We took him to an emergency room at a hospital in Atlanta but they couldn't diagnose and/or treat the condition. They recommended Shriners next door. They were able to diagnose the issue in a matter of a few hours - The ER doctor stated he had seen it once before - The slang term for the condition was "Scalded Skin Syndrome"; basically a type of staph infection caused by a spider bite - never did find the location of the bite though.
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Old 08-27-2017, 10:25   #30
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That looks like a condition my son suffered from when he was a toddler. We took him to an emergency room at a hospital in Atlanta but they couldn't diagnose and/or treat the condition. They recommended Shriners next door. They were able to diagnose the issue in a matter of a few hours - The ER doctor stated he had seen it once before - The slang term for the condition was "Scalded Skin Syndrome"; basically a type of staph infection caused by a spider bite - never did find the location of the bite though.
Staph Scalded Skin is not caused by a spider bite - again, it's typically related to a staph infection (commonly of the skin) and a result of the toxins released by the bacteria.
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