A Young Lady With a Rash (2006)December 2006
Issue 4, Vol. 1
Claude Luder,Sabine Schneiter,Jobst Greeve ,Werner-Josef Pichler*
Inselspital-University Hospital Berne, CH 3010 Berne, Switzerland
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An 18 year-old female patient was admitted with high fever (>39.5°C) for 3 days, dyspnoea, rash with edema of the face, both hands and feet (Fig. 1A and B). She showed diffuse lymphadenopathy and an enlarged liver.
At the age of 5 years, the patient was diagnosed with celiac disease. Since that time she adhered to a strict gluten-free diet. At age 12 the patient developed an insulin dependent diabetes mellitus (IDDM). Despite intensified insulin therapy, control of hyperglycemia had been difficult during adolescence. Four weeks prior to the actual admission, focal diabetic neuropathy developed with severe pain in the left leg. Treatment with carbamazepin at a dose of 3 X 400 mg for seven days was started. Because of persistence of severe pain attacks gabapentin was added in increasing doses up to 3 X 400 mg. Under this treatment a rash developed after 14 days.
* What is your differential diagnosis in this acute ill young patient with fever, rash and diffuse edema?