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Q: My husband has been having a problem with having a chill which turns into a fever which lasts from 12 to 18 hours, when it breaks. It leaves him very weak and sometimes sick to his stomach. After the fever breaks he has a rash on his left leg from his knee to his ankle which also has blisters. I know that you couldn't tell me for sure what is wrong with him without seeing him, but I was just wondering if you had ever heard of someone that had this happen tohim/her. By the way, he is going to the doctor to have it checked out. It has happened twice in the last month, this last time worse than the other. Before this month, it has happened several times over the years.
A: Clearly, there are a priori many possibilities which could account for your husband's symptoms and he should certainly go to the doctor to have it checked out. The differential diagnosis for a rash as you describe could include, for example, infectious disorders, autoimmune disorders, endocrine disorders, various possible malignancies, toxic disorders, etc. Typical conditions that come to mind among the infectious disorders which are characterized by the presence of blisters include bullous pemphigoid, pemphigus, impetigo, herpes, etc. However, the specific presentation as you describe do not necessarily suggest any of these diseases.
In the particular case of your husband, the physician should do a usual blood test, including liver function tests. Also, he/she should perform a careful physical examination to determine whether the rash is also present anywhere else in the body and to evaluate for any possible gland swelling, liver enlargement, or any other physical abnormalities. If the diagnosis is not apparent after proceeding in this fashion, the physician may have to perform a skin biopsy in order to more carefully evaluate the rash. By analysing the removed tissue and by also sending it to culture, if necessary, it might be possible to determine the cause of the rash. Quite generally, it is a priori quite difficult to really predict the cause, since many possible disease entities may lead to a very similar clinical presentation, as mentioned above.
Updated: 05/31/99
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