Reference no: EM132451723

Mr. Kramer is a 78 year old recent widower.   His wife just recently passed away and he felt an irritation under his right arm.  When he got home, he noticed a rash.  He relates this to sweating in a new suit jacket.  He denies other new hygienic products and no new laundering agents.  Since yesterday, he states the rash is beginning to spread.

PMedHx: DM 2 (1990)

                HTN  (1994)

PSurgHx:  Left knee arthroscopy

Family Hx:  Father, deceased:  CAD

                   Mother, deceased: complications from Lupus

                   Brother, alive 74:  HTN, Lupus

Soc Hx:  Retired banker with 3 grown kids

               Walks three times a week in a trail behind his house in a nature preserve; walks his dog on walking trails in woods

               Never a smoker; rare social ETOH use; no illicit drugs

               Watches carbs d/t DM

Meds:  Metformin 500mg BID

            Lisinopril 10mg QD

            ASA  81mg QD

            Atorvastatin 10mg QD (started on this 3 weeks ago)

Allergies:  PCN

ROS: 

General:  feels fatigued, associates this to wife's passing; denies fever or chills; hard to sleep d/t rash

Skin:  rash under right arm; doesn't itch a lot, but "burns"

Neck: supple; no lymphadenopathy

Lung: clear

CV:  RRR@78; normal S1 and S2; no mrg

Abd: soft, non tender

Skin:  Vesicular rash on erythematous base; linear in appearance; about 8-10 lesions noted

Question 1: Based on this patient's case, you believe he has what type of dermatology problem?

Question 2: What other subjective data would be important to inquire about in this patient?

Question 3: What diagnostics would you want to do on this patient?

Question 4: What would your treatment plan be for him?