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
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.
“Is Zoe of Mediterranean descent? I’m asking because her name means “life” in Greek. My parents are from Athens and several people in our family had a really scary autoimmune disorder with skin blisters. I think it’s called pemphigus vulgaris. Also, I noticed that Zoe has thyroid issues and that can be an autoimmune problem. My mother told me my aunt who had the skin blisters also had thyroid disease.”
— Athena L.
“Are Zoe’s doctors looking for signs of cancer? My friend’s daughter had leukemia when she was 10 years old and along with it she had paraneoplastic pemphigus that resulted in problems with her lungs. She did have blisters in her mouth. Happy ending: She survived and she just graduated from college!”
— Sarah P.
“Maybe Zoe has a staph infection. My son ended up with Scalded Skin Syndrome when staphylococcusbacteria got into an open cut after he fell down and scraped his knee. The bacteria produced poison that created blisters. He looked as though he had been burned and there were blisters nowhere near the site of the cut. The only thing is, he was a little kid and the doctor said this usually doesn’t happen to adults.”
— Roberta Z.
To be continued . . .
Come back to ThirdAge.com next Thursday when the dermatologist will reveal the actual diagnosis and treatment plan.
Marie Savard, M.D., a former Medical Contributor for ABC News and a frequent keynote speaker around the world, is one of the most trusted voices on women’s health, wellness, and patient empowerment. She is the author of four books, including one that made the Wall Street Journal list of the best health books of 2009: “Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About.” Dr. Marie earned a B.S. in Nursing and an M.D. degree at the University of Pennsylvania. She has served as Director of the Center for Women’s Health at the Medical College of Pennsylvania, technical advisor to the United Nations’ Fourth World Conference on Women in Beijing, advisor to the American Board of Internal Medicine Subcommittee on Clinical Competency in Women’s Health, health columnist for Woman’s Day magazine, and senior medical consultant to Lifetime Television’s Strong Medicine. Please visit DrSavard.com.