Management of Patients with Dermatologic Disorders

Case Study Exam

Please complete the following 2 case studies

Case 1

A 24-year-old man who regularly bites his fingernails accidentally tears out a small piece

of the corner of the nail on his right index finger. The damaged skin starts to bleed

lightly, so the man presses on the area with a tissue until the bleeding stops. Two days

later, the man notices that the finger has become infected. A small area of skin near the

corner of the nail is red and swollen. The skin is yellowish white in the center of this

area, where the swelling is most noticeable. The man, who knows just enough about

infections to be dangerous, opts to treat himself. He "lances" the center of the swollen

area with a needle that he sterilized by heating it in a candle flame. Pus then oozes out of

the opening, confirming the presence of infection. The man presses and squeezes the

area around the infection to force as much of the pus out the injured area as he can. He

removes the exuded pus with a sterile cotton ball, cleans the finger with a topical

antiseptic and covers the area with a small bandage.

Five days later, the man develops a fever and severe pain in his forearm. His arm is

swollen, red, and warm to the touch, so he gets worried and goes to the nearby ED for

advice. On examination, he appears sweaty and hot. His temperature is 40.40C. There is

a patchy red rash with poorly delineated edges on his right arm. The rash extends from

the elbow to the shoulder. Lymph nodes in the axilla are enlarged and tender. You are

the provider assigned to see the patient and you take the patient's recent history and

learns about the nail infection incident.

1. What is your diagnosis?

2. What are the most likely causative agents?

3. How can you identify the causative agent?

4. Does this agent cause any similar diseases?

5. What other agents cause this disease?