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Cause of a rare skin rash with fever and joint pains - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Skin Rash
Answered by

General & Family Physician
Practicing since : 2008
Answered : 3175 Questions
User :   Hi there. I have this, obviously, rare skin rash ... that as of yet, no other doctor (even Dermatologists), can figure out what it is. I've had it now for 3 solid years. I use Triamcinolone on it to keep it under control, though it never goes completely away. The rash worsens 10 days or so before my menstrual period. I had a punch biopsy of a lesion by a Dermatologist and it came back as Perivascular Lymphocyte Infiltrate. Keep in mind, at the time of the biopsy, I had only stopped using the topical steroid for about a week, which I'm assuming could have stopped the biopsy from showing its full potential. The rash is on my fingers, forearms, calves of my legs and a bit on my eyelids and mylar-type location. I also have fevers most all the time which never go over 100.6, joint pain and my thighs are sore, like a bruise, and the skin on them is numb'ish. So, I have many other body symptoms, including frequent headaches and extreme fatigue. The last time I had an ANA test was probably about 2 years ago. My GP has no idea what it is; but does believe it is an autoimmune condition. I've been tested 4 times for Celiac and Dermatitis Herpetiformis, both seriologically and pathologically, and all were negative. ANY ideas of what to suggest to my GP to test me for?
Doctor :   Hi
User :   Hi there.
Doctor :   let me read
User :   I'm just here to see if you might have some TESTS to suggest to my GP of what to check for. I think I must have some Autoimmune condition ... but trying to get to the bottom of this AGGREVATING condition I have.
User :   Ok ... please read.
User :   Oh! I almost forgot ...
User :   I do have Spherocytosis. I'm wondering ... could the Spherocytosis possibly cause false-negative blood tests? I know it seriously interfers with an ESR test.
Doctor :   no
User :   I have been REAL SICK the past couple weeks too. Real bad nausea and fever and fatigue. But, I'm better now.
Doctor :   spherocytosis do not cause the false positive reactions for the tests
Doctor :   ok
User :   Ok. Well, it was a thought anyhow :)
User :   My CBC he did on me a few weeks ago was completely normal.
User :   But, I have tested with a high Sed Rate before and usually always a high white blood cell count.
Doctor :   does the skin lesions and the symptoms do flare up if exposed to sun ?
User :   Yes, I believe I could say that for sure. When I get in the sun, it feels like my skin is frying when the sun hits it.
Doctor :   ok
User :   It's a real intense feeling ... like the sun is targeting my skin.
User :   My skin lesions are circles on me too.
User :   They're like circles with small papules and such. Not ringworm; was tested for that years ago.
User :   Red colored.
User :   The ones on my calves of my legs left a tiny bit of scarring when I get them to go away.
User :   I'm just SO sick at times and I feel like something is sneaking up on me and trying to prevent a serious trip to the hospital.
Doctor :   have yo been evaluated for lupus erythematosis ?
User :   I'm 42 ... by the way.
User :   Well ..
User :   I had the biopsy about 8 months ago.
User :   But, I had not stopped the steroids but for a week. I thought that might have stopped the biopsy from showing its full potential.
User :   It was Perivascular Lymphocyte Infiltrate ... which when I look that up on the web ... it is always near the "skin lupus" family.
Doctor :   yes
Doctor :   i got it
User :   The Dermatologist was honestly baffled with me and was at a loss.
User :   Maybe they've never seen what I have before and just don't know what to think about it and do about it. Not sure.
Doctor :   it is difficult to give a definitive diagnosis because many diseases do overlap with symptoms
User :   Here it is 9 days from my menstrual cycle and the rash is now worse again.
Doctor :   but one thing is for sure it is an autoimmune disorder
User :   Yes, I understand. What would you suggest I get tested for now?
User :   I fully agree. It is Autoimmune.
User :   What do you think about Dermatomyositis?
User :   I found that on the web that describes me.
Doctor :   and it may be lupus or polymorphous light eruption
User :   Because of the extreme fatigue and other body symptoms, I would have to lean towards the Lupus ... wouldn't you think?
User :   I guess I could save a spot on my skin and not apply steroids for a few weeks and then get the doc to biopsy that part of the skin ... as he said he would.
Doctor :   the exact diagnosis work up is of more so in terms of academic rather than treatment
User :   Right. I understand.
User :   Is it possible to have Lupus and still have a negative ANA?
Doctor :   as you said one spot you can leave it without treatment and get the biopsy done
User :   I have that rare blood disorder and am just wondering if something about my blood keeps it from turning positive.
User :   My GP is very young and he appreciates my suggestions. So, getting your opinions will surely help me and him both :)
User :   He's anxious to help.
Doctor :   yes it is very much posible to have lupus and the ANA is negative
User :   Well ... thank you for that opinion on the ANA. I have just been SO sick! I am a female; but I'm not a hormonal, crying, hypochondriac ... I'm just sick and want to feel better. So, your telling me that already makes me feel better.
User :   And, my mother, died at 45 with cancer and they found that SHE had LUPUS.
Doctor :   sorry to tell you this may turn into lymphoma (a cancer)
User :   So, I think I will just save up some skin then and go and get another biopsy like you said. That makes sense. And, definitely get another ANA and ESR as well.
Doctor :   so keep a watch on it
Doctor :   since you have a family history of it
User :   Well ... funny you mentioned Lymphoma. I'm having glands swelling lately too.
User :   I will go and get more tests.
Doctor :   do not panic
User :   THANK YOU so much for your opinions!!! It helps me feel more confident that maybe I'll get an answer soon.
User :   I'm not panicky. Too tired to panic :)
Doctor :   anxiety and stress do flare up the lesions

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