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Running Into Rash Decisions - Page #1
 

Author: Kimberly Burbank, MD
Co Author #1: Christopher Nelson, MD.
Co Author #2: Maggie Hansell, MD
Senior Editor: Christian Fulmer, DO
Editor: Juana Vargas, MD

Patient Presentation:
A 31-year-old female runner presenting with a rash that only occurs with exercise.

History:
The patient with IBS and seasonal allergies presents to PCP for a rash that occurs only with exercise. She reports diffuse, pruritic welts that develop several minutes into her runs. The welts come and go, along with linear red marks where she scratches. The rash subsides within an hour of exercise cessation. She does not have a rash with sweating or exposure to heat without exercise. She reports occasional lip and eyelid swelling, as well as flushing, palpitations, dyspnea, and nausea early in her runs. She denies symptoms with light activity. As a multi-sport athlete, she reports these new exercise-induced symptoms feel inappropriate to her. She denies similar symptoms prior to the last few months. She has not noted any food triggers prior to symptom onset. She denies childhood asthma or ectopy. She did have hives to naproxen once, but no recurrence of symptoms with recurrent exposure. No other allergies.

Physical Exam:
Vitals: BP 117/80. Pulse 66. Ht 5’3’’. Wt 137 lb.
General: Well-appearing, cooperative, good hygiene.
HEENT: Normocephalic, atraumatic. Eyes PERRL, conjunctiva clear.
Cardiac: RRR, normal S1/S2, no murmurs/gallops/rubs. No cyanosis or edema. Peripheral pulses intact.
Respiratory: CTAB, no wheezes or crackles.
Abdomen: Soft, non-tender, non-distended, no masses or HSM.
Neuro: CN II-XII grossly intact, motor and sensory grossly intact.
Skin: No rashes or lesions.
Mental status: No depression, anxiety, or agitation.


Case Photo #1

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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