EMERGENCY MEDICINEStories From the Field

Accurate Rash Description Leads to DRESS Syndrome Diagnosis

A patient presented with a fever and an angry-looking rash. Using VisualDx, I was able to describe the rash more accurately, moving beyond just ‘maculopapular,’ and it helped me formulate a comprehensive differential diagnosis. The resident and I used the app together, and we concluded that the patient had DRESS syndrome, leading to her admission.

—R.S., Shaare Zedek Medical Center physician

A Never-Before-Seen Rash is no Problem for Physician With VisualDx

I recently had an African American female patient who presented with complaints of weakness, feeling cold, and a new onset of a graphic rash on her posterior thighs, characterized by a repetitive reticulated pattern. Despite significant clinical experience, I had never seen this rash before, especially not in an African American patient.

The patient was extremely disappointed that I could not explain her rash,” says Dr. Holland, who also worked with Dr. Weed during medical school. “I checked VisualDx and, using the differential diagnosis features, I had a diagnosis within two minutes: Livedo reticularis (mottled skin linked to constricted blood vessels).

I showed the VisualDx picture to the patient, and she agreed that it matched her rash. We ordered additional tests, and she planned to follow up with her primary care provider. Having a firm diagnosis was reassuring for both the patient and me.

—R.H., UVM physician

Educating Tomorrow’s Physicians

I use VisualDx as part of our Emergency Medicine Residency educational program. We have 30-minute presentations on three topics, with one of the topics being rashes. The depth, breadth, and quality of information and images provided by VisualDx are extremely helpful in educating young emergency physician trainees.

—G.T., University of Illinois College of Medicine Peoria / OSF Saint Francis Medical Center attending physician

Easing Worries and Educating Parents

I hadn’t encountered a third-stage parvovirus rash before. A mother came into the Emergency Department alarmed that her teenage son’s viral rash was worsening and spreading to his arms and legs, especially in the sun or heat. Although her pediatrician had assured her that it was a benign parvovirus rash, she was still concerned about its progression.

As an emergency physician, I was unfamiliar with the fact that a parvovirus rash can last for several weeks and become more prominent in sunlight. Thankfully, I was able to look it up quickly, then walk in and show the mother pictures of other individuals with the same rash using VisualDx. It was clear that her son’s rash was a textbook example of parvovirus.

Often, worried parents lead us to perform unnecessary lab work or consultations, which can take hours, especially in children, and are primarily for the sake of educating the parents. Instead, I used the photo library in VisualDx to educate and reassure the mother without the need for labs or a consult.

—A.M., Children’s Hospital of Pittsburg physician

VisualDx Aids in Diagnosing Uncommon Pediatric Cases in the ED

During my shift in the ED, a patient presented with an unknown rash that had been present for 2-3 days without other systemic symptoms. Using VisualDx, I was able to classify the rash based on its color, texture, and description to narrow down the diagnosis. Even though it was between two possible rashes, VisualDx helped me communicate effectively with the family and reassure them about the management and treatment plan.

—H.H., Children’s Mercy Hospital resident

PA Finds the Right Treatment with VisualDx

A 34-year-old female patient returned to the emergency department after being seen a week earlier for redness on her forehead. She had been diagnosed with facial cellulitis and was discharged on Bactrim DS 1 tab PO BID for 10 days. Upon re-examination, there was extensive erythema and swelling now involving the right periorbital region. Using VisualDx, I reviewed the literature and identified a possible source of infection, noting the patient’s periodontal disease, poor dentition, tooth decay, and gingivitis. She had mild tenderness and erythema in the right maxillary sinus but was vitally stable with no signs of organ dysfunction. Given her lack of improvement on monotherapy and based on lab and physical exam findings, VisualDx recommended adding Augmentin. The patient was instructed to continue Bactrim and add Augmentin for the treatment of periorbital cellulitis.

—D.A., The Hospitals of Providence Northeast Freestanding ER physician assistant

Early Diagnosis for a Serious Condition

I had a young man with a rash I hadn’t seen before and was concerned it might be Fournier gangrene, even though he wasn’t septic and wasn’t diabetic. I used VisualDx’s algorithm to narrow down the diagnosis, and it turned out to be Fournier gangrene. We were able to diagnose it very early, which was crucial as he became very sick quickly while still in the ER. VisualDx was instrumental in helping me identify the condition and decide on the appropriate treatment course early on. Thanks for such a great product!

—R.E., Anne Arundel Medical Center physician