(P10) Overcoming Extensive Bullous Rash

Introduction: Sometimes, a routine admission will throw a curve ball and the unexpected happens! When a patient develops large areas of ulcerations after admission for shortness of breath, one must look at what was done, even if appropriate, and keep the differential diagnosis broad.

Case Description : 71-year-old Caucasian male presented to the ER with dyspnea, fluid retention and abdominal bloating. Diagnosed with acute heart failure
and atrial fibrillation with RVR, he was admitted to the ICU for cardiogenic shock, acute respiratory failure and shock liver. Developed body-wide rash with fluid filled blisters on hospital day 12. Patient was discharged to our nursing facility on day 10 of the rash, which progressively worsened for the first week until it slowly started to improve. We tried various treatments and coordinated care with dermatology and wound care specialists to facilitate the healing process - oral steroids proved to be the most beneficial.

Discussion: While his physical pain was quite difficult, the mental, social, and emotional discomfort was not forgotten.
Ultimately, the exact cause of the lesions remained indeterminate, but this case is a reminder of the importance of maintaining dignity for patients and collaboration of an interdisciplinary team to aid in relief of suffering.