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Suggest Treatment For Lower Back Pain And Low Grade Fever
Question: my dad 83 yrs old usually healthy as a horse and still chops his own wood gardens 10 acres recently 4days ago had neck pain headache which turned into lower back pain and much trouble walking, moving then a low grade fever and chills then involentarily, red oozing rash around both eyes and shaking in a neurological way, also had what looks like black dime sized blood blisters started as red ulcers unruptued on skin then turned bluish black and he became confused, had numbness in the palm of his left hand. he went on the morning of day 5 to his gp who instructed him to goto emerg , in which the bloodblisters spread to his right hand and the one on his thumb tripled in size while waiting 5hrs while tests being done
.. emerg took xrays urine and 2 blood samples 2 hrs apart and then sent him home with no treatment and a note to see a dermitologist.
with neurological type shakes not quite seizures but involuntary arm jerks and odd bloodblister (vacular issues?) we would very much appreciate additional opinions!
he is caucasian canadian no bug bites no cuts he had been spray painting about 4 days prior to symptoms
.. emerg took xrays urine and 2 blood samples 2 hrs apart and then sent him home with no treatment and a note to see a dermitologist.
with neurological type shakes not quite seizures but involuntary arm jerks and odd bloodblister (vacular issues?) we would very much appreciate additional opinions!
he is caucasian canadian no bug bites no cuts he had been spray painting about 4 days prior to symptoms
Brief Answer:
Differential diagnosis
Detailed Answer:
Hello,
Welcome to healthcare magic forum.
I understand from your query that your 83 year old father has developed sudden onset of neurological symptoms and hemorrhagic blisters on his body.
I have seen the picture that you have attached.
From your history and photograph, I would consider the possibilities of -
1. Vasculitis
2. Amyloidosis
3. Bullous pemphigoid
4. Senile purpura
Vasculitis is an inflammation of the blood vessels. It could be associated with neurological and cutaneous symptoms. The usual protocol is to take a skin biopsy to see the type of blood vessels involved and to do blood tests to determine the cause.
The treatment involves immunosuppressants like steroids initially followed by non steroidal immunosuppressants like azathioprine.
Amyloidosis could be primary or secondary. This needs a detailed work up to establish the cause and management depends on the cause identified.
Bullous pemphigoid is an auto immune disorder seen in elderly individuals. This is not associated usually with any neurological involvement. It could be a co-incidental association but I am keeping it in the list as a possibility based on the age and clinical picture of blisters.
Senile purpura presents as bruises on the body in elderly. This is again lower on my list as blisters are unusual and neurological association is only co-incidental
If possible, please upload a few more photographs ( especially the lesions around the eyes) so that I can assess better.
I hope you get to see your dermatologist at the earliest.
If you have any more queries, I will be glad to answer.
I hope this helps you.
Take care.
Regards,
Dr. Johny Chacko
Differential diagnosis
Detailed Answer:
Hello,
Welcome to healthcare magic forum.
I understand from your query that your 83 year old father has developed sudden onset of neurological symptoms and hemorrhagic blisters on his body.
I have seen the picture that you have attached.
From your history and photograph, I would consider the possibilities of -
1. Vasculitis
2. Amyloidosis
3. Bullous pemphigoid
4. Senile purpura
Vasculitis is an inflammation of the blood vessels. It could be associated with neurological and cutaneous symptoms. The usual protocol is to take a skin biopsy to see the type of blood vessels involved and to do blood tests to determine the cause.
The treatment involves immunosuppressants like steroids initially followed by non steroidal immunosuppressants like azathioprine.
Amyloidosis could be primary or secondary. This needs a detailed work up to establish the cause and management depends on the cause identified.
Bullous pemphigoid is an auto immune disorder seen in elderly individuals. This is not associated usually with any neurological involvement. It could be a co-incidental association but I am keeping it in the list as a possibility based on the age and clinical picture of blisters.
Senile purpura presents as bruises on the body in elderly. This is again lower on my list as blisters are unusual and neurological association is only co-incidental
If possible, please upload a few more photographs ( especially the lesions around the eyes) so that I can assess better.
I hope you get to see your dermatologist at the earliest.
If you have any more queries, I will be glad to answer.
I hope this helps you.
Take care.
Regards,
Dr. Johny Chacko
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi, I have provided some attachments. Please review them.
Brief Answer:
Differential diagnosis
Detailed Answer:
Hello,
I have seen the pictures that you have uploaded.
I would consider amyloidosis and vasculitis as the main possibilities.
I do hope you get to see the dermatologist at the earliest.
And I also hope this forum has helped you.
If you have any more queries, I will be glad to assist.
Wishing your father good health.
Regards,
Dr. Johny Chacko
Differential diagnosis
Detailed Answer:
Hello,
I have seen the pictures that you have uploaded.
I would consider amyloidosis and vasculitis as the main possibilities.
I do hope you get to see the dermatologist at the earliest.
And I also hope this forum has helped you.
If you have any more queries, I will be glad to assist.
Wishing your father good health.
Regards,
Dr. Johny Chacko
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
He had had canker sores which I just found out, plus memory lapses have been prevolent, amalayse looks different to what I see in him there's no purpea around the eyes, and the hands seem like thrombosis, however,
something that seems to fit all the criteria is the form of vasculitis of Behcet's disease
every one of his symptoms are in there
Emerg called dermatoligist which made appt for Nov 5th
since there's only topicals, steroids and ummunosuppressents I wonder if in the meantime since theyre essentially non-toxic in low doses - and
-Lysine (for the herpes)
-Iodine in pill form from kelp for the infection and ultimately fever
-a tincture with echinacea and XXXXXXX d'arco combo to help the immune system
-msm to reduce the inflammation for the pain in neck back and inflamed veins - thrombosis
-white willow to help thin the blood so it doesn't go any more globby and clot
all to Recommended specifications
to keep it at bay until the dermatologist appt in two weeks
each one of the above will not interfere with each other, nor if it is not behcet's will not be adverse to him
with the fever I don't want it spreading in either the brain or the central nervous system
:)
thoughts?
purpura ful´minans
or
Meningococcal disease
Menigococcemia
symptoms fit these as well
thrombosis is spreading - elbows knees
as well as further up wrists and hands
something that seems to fit all the criteria is the form of vasculitis of Behcet's disease
every one of his symptoms are in there
Emerg called dermatoligist which made appt for Nov 5th
since there's only topicals, steroids and ummunosuppressents I wonder if in the meantime since theyre essentially non-toxic in low doses - and
-Lysine (for the herpes)
-Iodine in pill form from kelp for the infection and ultimately fever
-a tincture with echinacea and XXXXXXX d'arco combo to help the immune system
-msm to reduce the inflammation for the pain in neck back and inflamed veins - thrombosis
-white willow to help thin the blood so it doesn't go any more globby and clot
all to Recommended specifications
to keep it at bay until the dermatologist appt in two weeks
each one of the above will not interfere with each other, nor if it is not behcet's will not be adverse to him
with the fever I don't want it spreading in either the brain or the central nervous system
:)
thoughts?
purpura ful´minans
or
Meningococcal disease
Menigococcemia
symptoms fit these as well
thrombosis is spreading - elbows knees
as well as further up wrists and hands
Brief Answer:
Does not look like Behcet's disease
Detailed Answer:
Hello,
I apologize for the delay in replying.
In my opinion, it does not appear to be Behcet's disease.
In both Purpura fulminans and meningococcal disease, the patient will be very sick and may even be in altered sensorium.
You could give an over the counter multivitamin temporarily. It will also help the canker sores.
You could also try the herbal supplements that you have mentioned. I am sorry I do not have much experience in herbal medications so I will not be able to help you in that.
Thrombophlebitis / Thrombosis is usually associated with pain and swelling of the affected limb. From your pictures, it does not seem to me that way.
I hope you have received some help in the emergency because the wait for the dermatologist' s appointment is still quite a few days away.
Please write in if you have any other queries.
Regards,
Dr. Johny Chacko
Does not look like Behcet's disease
Detailed Answer:
Hello,
I apologize for the delay in replying.
In my opinion, it does not appear to be Behcet's disease.
In both Purpura fulminans and meningococcal disease, the patient will be very sick and may even be in altered sensorium.
You could give an over the counter multivitamin temporarily. It will also help the canker sores.
You could also try the herbal supplements that you have mentioned. I am sorry I do not have much experience in herbal medications so I will not be able to help you in that.
Thrombophlebitis / Thrombosis is usually associated with pain and swelling of the affected limb. From your pictures, it does not seem to me that way.
I hope you have received some help in the emergency because the wait for the dermatologist' s appointment is still quite a few days away.
Please write in if you have any other queries.
Regards,
Dr. Johny Chacko
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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