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Suggest treatment for rash

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Posted on Mon, 6 Oct 2014
Question: Okay-My 21 year old son has had some weird symptoms the past 3 weeks. He has seen a doctor an infectious disease specialist and had losts of tests. Lyme was first thought but ruled out. He started with sore feet, then he began to have intermittent joint pain/tightness mostly in knee, ankle or hands/fingers. He developed a rash on his back/cject which he googled and said looks like a rash called erythema marginatum.Otherwise he feels ok. He goes to classes, walks around and does not really look or feel sick. The infectious disease guy said alll his blood tests were negative except for one marker which indicated inflammation was going on. He suggested Will go to a dermatologist to look at the rash, or it might be a virus. Apparently the rash is much better today. However, I am very worried and having a panic attack over this, Any ideas. He is otherwise a health 21 year old. I was worried about Lupus but that seems unlikely and he has not butterfly rash nor any rash on his face, Only check and back.
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Answered by Dr. Eric Goldstein (2 hours later)
Brief Answer:
Rash

Detailed Answer:
Hello. I just read through your question.
Sounds like your doctor did a pretty thorough investigation.
Erythema Marginatum, as you've probably already learned, is associated with Acute Rheumatic Fever. This is typically brought on by an untreated Strep infection somewhere in the past. This doesn't seem likely. Also, I'm sure your doctor already tested for it.
In the pediatric age range, even a 21 year old, the most likely diagnosis left is a viral infection, as you mentioned. The dermatologist will help out here. But there isn't any reason to panic. It will resolve and he will be fine.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Eric Goldstein (1 hour later)
Dr Goldstein I appreciate your response. I am not sure what tests the infectious diease doctor did. However, he did mention to Will that all of his blood tests were normal except one marker that was very hight-the one that showed inflammation. Looking at the other symptoms of Rheumatic fever-joint pain and intermittent fever-it almost seems classic. The whole thing started with joint pain.

And of course he has that distinctive rash. It is possible he had strep once and it was untreated. I am wondering about the possibility of Rheumatic Fever. Should I have him go to the health clinic at Tufts tomorrow. Is there a test they can do for this? he was on antibiotics for a week (doxatricline sp?) I believe. The symptoms actually seemed to subside and then he stopped taking it and they recurred. He was on it initially because they thought he had Lyme. Thanks for being so helpful. I realize it might also be a virus. Can a virus cause that kind of rash and inflammation? Again he does not feel sick.
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Answered by Dr. Eric Goldstein (25 minutes later)
Brief Answer:
Folliw Up

Detailed Answer:
Thank you for the follow up question.
I would first ask your doctor if he thought about Rheumatic Fever and if he did blood work to rule it out. If he did, we can scratch it off the list.
Also, keep in mind, the blodd test that showed inflammation is a very nonspecific test. Even a virus can give that result.
Considering your son is feeling fine, I would consult your doctor about Rheumatic Fever and cinsult with the dermatologist before doing anything more dramatic.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Eric Goldstein

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Suggest treatment for rash

Brief Answer: Rash Detailed Answer: Hello. I just read through your question. Sounds like your doctor did a pretty thorough investigation. Erythema Marginatum, as you've probably already learned, is associated with Acute Rheumatic Fever. This is typically brought on by an untreated Strep infection somewhere in the past. This doesn't seem likely. Also, I'm sure your doctor already tested for it. In the pediatric age range, even a 21 year old, the most likely diagnosis left is a viral infection, as you mentioned. The dermatologist will help out here. But there isn't any reason to panic. It will resolve and he will be fine.