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Solve the Medical Riddle: She Has Blisters in Her Mouth and on Her Body, Third Week

By Marie Savard MD

Editor’s note: Welcome to our ThirdAge feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

The first week of this riddle, the patient reported her symptoms to a doctor who referred Zoe to a dermatologist associated with a university. The second week, the dermatologist proceeded with the examination using the classic S-O-A-P notes as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

 

This week, we’ll let you know what some people have suggested as possible diagnoses. Next week, the dermatologist will reveal the actual diagnosis. Then we’ll begin a new riddle for the following month!

 

Some Guesses as to What the Diagnosis Will Be

 

“My cousin had horrible skin lesions that turned out to be caused by a condition called Stephens-Johnson syndrome that can be life-threatening. She went to Urgent Care on a Sunday when her face started swelling. Good thing she did that! The Urgent Care doctor told her that he had been taught that her symptoms pointed to one of two potential emergencies for a dermatologist. She doesn’t remember what the other one was. Anyway, she was hospitalized and her recovery took several months. The thing was, though, my cousin had been taking  a sulfa based antibiotic for a urinary tract infection and didn’t remember to tell anyone when she first got a rash. However Zoe’s doctor said her blisters probably were not drug-related and Zoe was questioned in detail by both her family doctor and the dermatologist.

— Millie R.

“I had something called erythema multiforme minor with blisters all over my skin. My doctor diagnosed it with the Nikolsky sign that Zoe’s doctor mentioned. Fortunately, my problem wasn’t serious so I hope that’s what Zoe has! My doctor never knew what caused my condition, but it could have been from the herpes simplex virus that causes chicken pox and shingles.”

— Renee G.

“Maybe Zoe is just freaking out about her daughter’s wedding! I was totally stressed for the whole year of planning when I was the mother of the bride-to-be. I got hives and rashes and headaches and stomachaches. Maybe I’m more anxious than some other people, but honestly wedding planning is crazy! The worst part was trying to get along with my son-in-law’s parents. They were pushing for a destination wedding that would have cost a fortune. My husband and I were footing the bill so we didn’t appreciate that. All I’m saying is that Zoe could be breaking out because of nerves. P.S. I get along with my son-in-law’s parents now. : -)”

— Colleen B.

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