General Question

Judi's avatar

The doctors are stumped. Blood tests are clear, what in the world could be causing this rash?

Asked by Judi (39850points) December 29th, 2009

We came back from a medical mission to Guatemala. My husband first got a terrible sinus cold, them got this horrible rash. It started on his flanks. It doesn’t blister. It just itches so bad that he will have bruised streaks in the morning from scratching in his sleep.
It seems to be symmetrical. If it is on his right flank it will be in his left flank. It seems to stay there for a while them migrate to his thighs, calves, back, arms, always on both sides of his body in the same place.
They put him on prednisone and it knocked it down, but as soon as he started to taper down it came back. Prednisone is nasty stuff and I know he doesn’t want to stay on that for long.
I realize that you are not doctors, I am just trying to brainstorm to see if there is something someone might have heard of that the doctors are missing.
Ruled out valley fever (we live in an area where it’s prevalent) and scabies. Did a crap load of blood tests and a chest x-ray.
Where’s Dr. House when you need him??

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33 Answers

Flo_Nightengale's avatar

If you were out of the country and this developed after your return, it could be something he picked up in Guatemala. I am not a doctor but I did look up the symptoms then I suggest you contact the Center for Disease Control (online or they are located in Atlanta, GA) and they could direct you to a physician in your area that could administer tests for a more definitive diaganosis. Good Luck!

syz's avatar

I, too, would recommend that you try to find a tropical diseases specialist.

gemiwing's avatar

What were they looking for in the blood work?

Judi's avatar

@gemiwing ; apparently they have ruled out parasites in his blood and they did blood cultures and said nothing was growing there. They also did all the normal, blood tests for general health. He’s a really healthy guy. There was a “shadow” on the chest x-ray that the doctor said was probably due to the cold he had at the beginning. They can’t do a TB test because they have had him on prednisone and that will keep the test from reacting.

gemiwing's avatar

@Judi I agree with the others, it’s time to call the CDC and find a tropical specialist. It could be something so simple that it’s being overlooked too.

Judi's avatar

I sent an email to the CDC. It is making him a bit cranky. I want my happy hubby back!!
We were in the Mountains at Huehuetenango, so we were not exposed to to much “tropical.” We did go to Antigua for 1 day when we got back but that was pristine.

Flo_Nightengale's avatar

I hope they can help you or at least direct you. He must be miserable :-(

Judi's avatar

Were willing to travel to get this figured out. Bakersfield is not known for it’s great medicine, although I do believe we have the best GP and dermatologist in town.

Flo_Nightengale's avatar

I am sure there is a branch of the CDC close by. They also work with the Department of Public Health. Keep up posted of you don’t mind. I’ll say a prayer.

nebule's avatar

Dr House is busy with my DVD player….

Hope you get it sorted soon Judi xx

EmpressPixie's avatar

You could try asking about skin-based parasites or fungus. Did they rule out allergies?

I have no knowledge in this field, just brainstorming.

Dog's avatar

The areas it is starting in are areas where the skin is thinner and can absorb irritants easier. I am wondering about bacterial or allergen.

Questions:

Did he ride a pack animal while there?
Did he buy new clothes while there?
Did he wash his clothes in different detergent?
Did he swim?
How long have you been home?
Have you washed out everything since then including the car you came home in?
Did you purchase a blanket ?

Think of what might be touching his skin while he is damp either with perspiration or from showering as a first possibility.

I would find a dermatologist and ask for a bacterial culture to be run on the scrapings from the rash.

Judi's avatar

Oh, I forgot to say they did a biopsy as well!

Judi's avatar

@Dog ; yeah, those are all things we have ruled out. We came back in OCTOBER!!!!

Dog's avatar

Have they done bacterial cultures?

Judi's avatar

Isn’t that what tehy do when they do blood cultures?

Dog's avatar

The bacteria might be topical and not blood borne.

Did they took a sample directly off the rash and culture it?

Judi's avatar

@Dog ; They took a big old honking slab of skin and biopsied it. They had to stitch it back up. I don’t know if they did a culture on the biopsy tissue though.

Judi's avatar

I was wondering if it could be neurological since it’s symmetrical on both sides of his body.

Dog's avatar

Your poor husband!
I am alerting @nikipedia to this question. Hopefully she will chime in regarding neurology.

RedPowerLady's avatar

Could it be simply an allergic reaction? If it is your first trip to Guatemala there could be tons of possible allergens. And different allergens will react differently. Just a thought.

Judi's avatar

@RedPowerLady ; but wre’ve been home since October.

shilolo's avatar

You need to see an Infectious Diseases specialist, which should be fairly easy to identify. You don’t need the CDC, yet. As for your husband’s condition, without seeing the rash, it is hard to tell. The travel history, itchiness and migratory nature of the rash suggests cutaneous larva migrans. Other possibilities include cutaneous leishmaniasis, lyme, leptospirosis, coccidiomycosis, or histoplasmosis.

Judi's avatar

@shilolo ; altough he has coccidioidomycosis anti bodies, it has been ruled out. We live in Bakersfield and almost everyone has had valley fever at some point.
Would the cutaneous larva migrans show up in blood cultures or in the biopsy?
They have ruled out Lyme Disease.
Looking at pictures online I am fairly sure it’s not Cutaneous Leishmaniasis, because the rash never erupts. He also had a punch biopsy and according to what I read, it should show up there.
After researching leptospirosis, I can see how he would be at risk. he was a McGyver and did his share of plumbing in an antiquated system. Wouldn’t all the other liver symptoms have appeared by now though?
When they do a biopsy, do they culture it or just look at it and throw it out? Does the doctor have to specifically order that the biopsy be cultured?
I just want to make sure that nothing is missed. I would hate for him to have something that is treatable if caught early enough, but not be able to figure it out.

filmfann's avatar

It sounds like it is anti-immune related. Have you tried any other steroids?

Judi's avatar

@filmfann ; Just the super duper prescription cortisone creams and ointments.

Flo_Nightengale's avatar

Any news from the CDC as of you?

Judi's avatar

No answers yet.

shilolo's avatar

@Judi Would the cutaneous larva migrans show up in blood cultures or in the biopsy?
One would have to order specific serologies and/or request special stains on the biopsy. It has to be done at the leading edge of the rash.

Looking at pictures online I am fairly sure it’s not Cutaneous Leishmaniasis, because the rash never erupts. He also had a punch biopsy and according to what I read, it should show up there.
Again, the pathologist has to be made aware of this possibility.

After researching leptospirosis, I can see how he would be at risk. he was a McGyver and did his share of plumbing in an antiquated system. Wouldn’t all the other liver symptoms have appeared by now though?
Most likely, yes.

When they do a biopsy, do they culture it or just look at it and throw it out? Does the doctor have to specifically order that the biopsy be cultured?
It truly depends on what the doctor orders. There are a million and one tests you can do, and the lab doesn’t do them all since each one requires some tissue and also has it’s own costs, etc. Routine culture and stains are typically done. After that, it’s totally up to the ordering doctor.

I just want to make sure that nothing is missed. I would hate for him to have something that is treatable if caught early enough, but not be able to figure it out.
Where do you live? There must be an academic medical center nearby with an Infectious Diseases group. Request an appointment there ASAP.

Judi's avatar

@shilolo ; We’re in Bakersfield but we also have a home in Orange County. We could probably go to UCLA, but it is crazy trying to figure out how to get an appointment with the right person there. It seems like the only way to really get seen is to go to the emergency room.

shilolo's avatar

It shouldn’t be that hard. Try calling here.

Nullo's avatar

It sounds dermal, if it’s not showing up in the bloodwork.
Kind of ironic, if you ask me.

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