Case Report: Enigmatic leg rash

I was consulted recently at our walk-in clinic about a recent (and recurrent) rash on the legs of a 30-year-old, fair-skinned male. Two days prior to being seen, the patient woke up to find itchy patches on his lower legs: two on the front of one lower leg, one on the back of his other leg. He conveniently “posed” to show all spots— otherwise the picture would suggest that his legs were oriented in opposite directions. Read: Case Report: A limp and a rash The young man was in excellent health, with no allergies and taking no medications. He had not treated the rash and was concerned about its cause. Curiously, he had experienced a similar rash a week previously—the pigmented remnant visible below the current rash, in the picture. He slept alone, and had no contact with anyone having a similar rash. The patient had not been exposed to any household or environmental substances. He had been at home, not outside in grass or other locations where he might have encountered insects. He had checked thoroughly for insects in his bed, and had even washed his bedclothes after the first experience thinking of bed bugs. His home and social environment did not suggest that bed bugs would be present, but apparently one can never be sure. Read: Case Report: Tick rash? Although the lesions suggest insect bites, the extent and degree of erythema surrounding them is perhaps unusual. Historically, it would seem that he had been “bitten” during the night. However, I wondered about folliculitis or vasculitis. Precautions had been taken—I suggested repeat washing of bedding. Empirically, I prescribed twice-daily application of Fucibet cream. It will be interesting to see if the patient keeps developing lesions in the future. I wonder if anyone thinks the rash could be anything other than insect bites? Dr. Robert Dickson is a family physician in Hamilton. This report is based on a real case from Dr. Dickson’s files. Read: Case Report: Not this rash again!

Case Report: Enigmatic leg rash

Register for free access or login.

Related Topics