Unidentified Rash in Older Woman Baffles Multiple Clinicians
(HealthDay News) — In a case report published in the October issue of the Journal of the American Geriatrics Society, the authors describe a case of bedbugs in an older woman who presented with an unidentified itchy rash.
Jordana Laks and Lindsay A. Wilson, M.D., M.P.H., from the University of North Carolina at Chapel Hill, document the case of a 93-year-old woman who presented to her primary care physician with two weeks of an itchy rash, and red lesions that appeared in clusters and resolved over one week.
The authors note that a dermatologist, allergist, and primary care physician failed to identify a definitive etiology of the patient's rash over the next several months. The lesions were not affected by discontinuation of each of her medications. Treatment with second-generation antihistamines, topical corticosteroids, and an oral corticosteroid resulted in partial relief from edema and pruritus, but the lesions continued to arise; side effects were reported from the oral corticosteroid. The daughter of the patient found two insects near the woman's bed four months after the initial presentation. The insects were identified as bedbugs; in hindsight, the patient reported having seen them earlier.
"The extensive evaluation, medication changes, and side effects of corticosteroid treatment could have been avoided if the insects had been detected sooner," the authors write. "Providers should inquire about bedbugs when an older adult presents with a persistent urticaria-like rash of unknown origin."