[43M] With facial lesion, tongue sore, and recent systemic symptoms

Patient Description

A 43-year-old male presents with a crusted facial lesion that appeared suddenly three days ago, following a skin rash and blisters. The rash initially manifested as red bumps resembling bug bites, which then developed into blisters. Additionally, the patient reports a painful sore on the top of the tongue that started as a bump two days ago. Prior to these symptoms, the patient experienced a high fever, body aches similar to flu symptoms, extreme tiredness, and excessive sweating sufficient to soak clothes and bedding. The body aches have since subsided. The patient has a history of HIV with an undetectable viral load and missed a few doses of medication recently but is now current. There is also a history of Lyme disease from childhood and frequent mouth sores over the past year. The patient is currently taking Genvoya, doxycycline 100mg twice daily, and cephalexin 500mg every six hours, with no known allergies.

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Arora's Assessment

What might be happening

Based on your symptoms and history, here are some possibilities:

  1. Herpes Simplex Virus (HSV) Infection: The sudden appearance of blisters and crusted lesions, along with mouth sores, could suggest a herpes infection. HSV can cause painful blisters on the face and mouth.

    • Treatment typically involves antiviral medications prescribed by a doctor.
  2. Impetigo: This is a bacterial skin infection that can cause blisters and crusting, often around the face.

    • Treatment usually involves topical or oral antibiotics.
  3. Shingles (Herpes Zoster): Given your history of fever and body aches, shingles could be a possibility, especially if the rash is painful.

    • Antiviral medications can help if started early.
  4. Contact Dermatitis: Exposure to floodwaters might have caused an allergic reaction or irritation.

    • Avoiding irritants and using topical treatments can help.

What you can do

  • Consult a Healthcare Provider: It's important to see a doctor for a proper diagnosis and treatment plan.
  • Keep the Area Clean: Gently clean the affected areas with mild soap and water.
  • Avoid Scratching: Try not to scratch the lesions to prevent infection.
  • Use MDandMe: Track your symptoms and any changes to share with your healthcare provider.

What you should look out for

  • Increased Pain or Swelling: If the lesions become more painful or swollen, seek medical attention.
  • Fever or Chills: If you develop a fever again, contact your doctor.
  • Spreading Rash: If the rash spreads or new symptoms appear, see a healthcare provider.

Remember, it's important to consult with a healthcare professional for an accurate diagnosis and appropriate treatment.

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6 mo ago

People Also Ask


What are the common symptoms of a Herpes Simplex Virus (HSV) infection?

Common symptoms of a Herpes Simplex Virus (HSV) infection include painful blisters or sores on the face, mouth, or genitals, itching or tingling sensations before the blisters appear, and sometimes flu-like symptoms such as fever and body aches.


How can impetigo be treated effectively?

Impetigo is typically treated with topical or oral antibiotics. It's important to keep the affected area clean and avoid touching or scratching the lesions to prevent spreading the infection.


What are the early signs of shingles and how is it treated?

Early signs of shingles include pain, burning, or tingling in a specific area, followed by a red rash that develops into blisters. Treatment involves antiviral medications, which are most effective when started early, as well as pain management.


What should I do if I suspect contact dermatitis?

If you suspect contact dermatitis, try to identify and avoid the irritant or allergen causing the reaction. Use mild soap and water to clean the affected area, and consider applying topical treatments like corticosteroid creams to reduce inflammation. If symptoms persist, consult a healthcare provider.


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