25410034 Visualization

A 21 Age - year Age - old Age man Sex presented Clinical_event to the emergency Nonbiological_location department Nonbiological_location with a rash Sign_symptom on his arms Biological_structure and neck Biological_structure (figure 1).
It Coreference had developed over Duration the Duration course Duration of Duration 36 Duration   h Duration from discrete Detailed_description ‘pin Detailed_description prick’ Detailed_description areas Detailed_description of erythema Sign_symptom into a maculopapular Detailed_description rash Sign_symptom with vesicles Detailed_description (figure 2).
It Coreference covered his forearms Biological_structure from the dorsal Biological_structure aspect Biological_structure of Biological_structure the Biological_structure hands Biological_structure to the flexor Biological_structure surface Biological_structure of Biological_structure the Biological_structure elbows Biological_structure .
It Coreference was also beginning to develop around his neck Biological_structure (figure 3).
He described the rash Sign_symptom as itchy Detailed_description and painful Detailed_description , and was feeling Diagnostic_procedure ‘ under Lab_value the Lab_value weather Lab_value ’.
The patient had no History previous History dermatological History or History other History medical History history History of History note History .
He took no medication Medication .
He worked Occupation in Occupation a Occupation supermarket Occupation handling Occupation food Occupation items Occupation but there was no History history History of History occupational History chemical History exposure History .
He had History not History recently History had History any History change History in History washing History powder History or History personal History hygiene History products History .
Physiological Diagnostic_procedure observations Diagnostic_procedure were entirely normal Lab_value and systemic Diagnostic_procedure examination Diagnostic_procedure unremarkable Lab_value .
Closer examination Diagnostic_procedure of the rash Sign_symptom revealed that it was present only on skin Biological_structure exposed Activity to Activity the Activity sun Activity when wearing Activity a Activity short Activity - sleeved Activity shirt Activity ; the most striking feature was the ‘V’ Other_entity shape Other_entity on Other_entity the Other_entity patient's Other_entity chest Other_entity in keeping with the neck line of a polo shirt.
On further questioning the patient described a period of time 48 Date   h Date prior Date to presentation (and 12 Date   h Date prior Date to the development of the rash Sign_symptom ) spent strimming Activity the Activity grass Activity under the hedges in his garden.
Blood Diagnostic_procedure tests Diagnostic_procedure including full Diagnostic_procedure blood Diagnostic_procedure count Diagnostic_procedure , urea Diagnostic_procedure and electrolytes Diagnostic_procedure , liver Diagnostic_procedure function Diagnostic_procedure test Diagnostic_procedure and C Diagnostic_procedure - reactive Diagnostic_procedure protein Diagnostic_procedure were all within Lab_value normal Lab_value reference Lab_value ranges Lab_value .
The list of potential differential diagnoses for a maculopapular rash is long, but given the distribution of the rash and the history of plant material exposure a diagnosis of phytophotodermatitis Disease_disorder was made.
The patient was discharged Clinical_event with chlorphenamine Medication , simple Medication analgesia Medication and the advice Other_event to Other_event wear Other_event a Other_event long Other_event - sleeved Other_event t Other_event - shirt Other_event and Other_event sunscreen Other_event when gardening in the future.
The rash Sign_symptom resolved over a period Duration of Duration 3 Duration   weeks Duration .
It Coreference remained pruritic Detailed_description throughout healing but the associated pain Sign_symptom settled over Duration a Duration few Duration days Duration .
Residual scarring Sign_symptom is beginning to fade 2 Date   months Date after Date presentation.