Today our amazing PGY-2, Dr. Alexis Quade, led us through an interesting case of an elderly woman who initially came in with some knee pain but was found to have an AKI and sepsis in the ED. We found out that she had untreated psoriasis, a bioprosthetic valve and a recent Staph Aureus UTI. Her exam was notable for extensive, near full body, erythematous desquamating lesions sparing mucosal membranes, with a yellowish crust but otherwise hemodynamically stable that was concerning for erythroderma. Our expert discussant from dermatology, Dr. Nell Haddock, helped us learn about the pathophysiology of erythroderma and the most common disease processes that will cause this condition. Dr. Quade reminded us that erythroderma, given the large degree of vasodilation and shunting of blood flow, can be a cause of high-output heart failure. Ultimately, the patient was diagnosed with impetiginized psoriasis and staph bacteremia and greatly improved with IV antibiotics and topical steroids.
Teaching Points:
1) Remember to look for possible bacteremia and occult infection in patients with Staph bacteruria
2) Erythroderma is a dermatologic emergent condition that is defined by an exfoliative dermatitis that covers over 90% of the body and is caused by a number of disease states.
3) Treatment includes aggressive wound care and hemodynamic monitoring given large degree of insensible losses and control of underlying disease process. Remember, do not use oral steroids for psoriasis flares, start with topical steroids +/- immunologics!
Thank you again, Dr. Quade, for the great case and to Dr. Haddock, for your amazing teaching!