A 9-yo girl presented with 1 mo of itchy blisters and erosions on her extremities. She had no recent infections or travel, and was on no medications. She recently got a puppy. Exam revealed a few tense blisters on the arms, no mucosal involvement.
Tinea corporis
Toxic epidermal necrolysis
Porphyria cutanea tarda
Lyme disease
Bullous insect bite reaction
You are correct. Insect bites more commonly result in urticarial papules, but can result in vesicles or bullae. In this case, bullae are likely to be caused by dog flea bites. Exposed extremities are usually affected. Antigens in flea saliva produce a hypersensitivity reaction. There is usually no reaction after the first bite; reactions develop with repeat bites. Reactions gradually lessen after prolonged exposure; ultimately the patient becomes immune.
An elderly woman on Coumadin presents to the ED 1 day after left eye surgery complaining of pain and vision loss. What is the diagnosis?
Hyphema
Acute angle-closure glaucoma
Retrobulbar hemorrhage
Orbital cellulitis
Periorbital postoperative hematoma
You are correct. A retrobulbar hemorrhage is a vision-threatening emergency that presents after trauma or surgery with painful proptosis, a difference in globe compressibility, ophthalmoplegia, double vision, decreased visual acuity, decreased pupil responsiveness, cherry red macula, and nerve head pallor. Immediate decompression with lateral canthotomy is indicated. The patient went to the operating room for emergent decompressive surgery and regained full vision in her eye.