Herpes Zoster, Blue Sclerae: What’s Your Dx?

QUESTION 1:

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This lesion developed over a 3-week period.

QUESTION 2:

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For more than a week, a 74-year-old man has had diminished vision in his left eye. The problem started acutely with a sensation of flashing lights in the affected eye, followed by dark floaters. He initially had minimal vision loss in the lateral (temporal) field, but with each day the loss has become more profound and central; it now significantly impedes his ability to read and perform activities of daily living. He denies headaches or other neurological symptoms either before or during this episode. He has had mild hypertension.

QUESTION 3:

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A 5-year-old boy presented with left leg pain. He identified an area just above the medial malleolus as most painful, and the pain worsened with movement. The child had received all appropriate immunizations except for a second dose of varicella vaccine; he had received the first dose at the age of 1 year. After 2 days, the pain continued and an erythematous papulovesicular rash developed on the medial aspect of the left thigh, leg, and foot. Herpes zoster was diagnosed.

QUESTION 4:

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A young woman remembers the trauma from the many broken bones she experienced during her childhood. She also remembers how, in the emergency department, her mother would recount her own history of fractures throughout her own childhood and adult hood. A notable feature was the child’s blue sclera.

QUESTION 5:

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A 6-year-old boy presented with a 1-month history of an intensely pruritic “rash” that involved the left dorsal foot and left lower leg. He had a recent history of walking barefoot on a beach in Florida where dogs are allowed.

ANSWER KEY:

Question 1. Answer: b

Question 2. Answer: c

Question 3. Answer: d

Question 4. Answer: d

Question 5. Answer: a