Eczema Herpeticum Misdiagnosed as Facial Cellulitis in an African American Male.

Eczema herpeticum (EH) is a cutaneous manifestation of disseminated herpes simplex virus, commonly observed in patients with active eczema. The condition often presents with systemic symptoms, including fever and fatigue, alongside vesiculopustular skin lesions. This case report describes a 19-year-old male with active eczema who was misdiagnosed with facial cellulitis in the emergency and inpatient setting in a community tertiary hospital. With worsening rash and development of ocular symptoms, the diagnosis was reconsidered to be more consistent with EH with herpetic keratitis, which improved with antiviral treatment. This report shows the significance of maintaining a high index of suspicion for EH in patients with eczema and the potential consequences of misdiagnosis and delay in treatment. It aims to enhance clinician awareness of EH and promote a broader differential for unusual presentations of common dermatological and ophthalmologic conditions, especially when caring for patients with limited access to specialist evaluation.

Extraction of a Central Incisor From the Plica Fimbriata in the Outpatient Family Medicine Office: What's That Rattle?

All-terrain vehicle (ATV) accidents are all too common in the United States and can result in long-term injuries. Therefore, proper after-care is essential for the recovery of an injured person. Here, we present a case where an embedded tooth was overlooked for almost an entire year after an ATV accident. No imaging was performed despite multiple clinic and emergency department visits. The tooth was not discovered to be embedded within the tongue until it later started migrating and protruding. Therefore, extraction was performed in the office.

Spontaneous Multiloculated Lumbar Abscess in a Middle-Aged Male With Unexplained Progressive Back Pain and Muscle Weakness.

A 54-year-old man with a past medical history significant for sciatica, as well as multiple orthopedic surgeries with hardware, was transferred from an outside rural facility for further workup of a two-month history of progressive back pain and muscle weakness. Investigations ultimately revealed abnormal enhancement from T11 to sacrum, with a large epidural abscess from L5 to the sacrum, best visualized on an MRI. Following the MRI confirmation of loculated complex thoracolumbar abscess, neurosurgery performed a left L3-S1 unilateral laminotomy and evacuation of compressive multiloculated epidural abscesses. The patient was then treated with empirical antimicrobial coverage for epidural abscess with vancomycin and ceftriaxone, which was narrowed to cefazolin based on positive methicillin-susceptible Staphylococcus aureus (MSSA) wound cultures obtained in the operating room. The patient completed a total six-week course of antibiotic therapy. Apart from some superficial wound dehiscence postoperative, the patient ultimately recovered well and had a resolution of most presenting symptoms.

Polyuria and Acute Hyperglycemia Secondary to New-Onset Diabetes in a Young Woman With Friedreich's Ataxia.

A 23-year-old woman with progressive Friedreich's ataxia (FRDA) presented to a local urgent care facility for urinary urgency and frequency. A urinalysis showed the presence of trace ketones and glucose, and point-of-care testing revealed severely elevated glucose. The patient was referred to the emergency department and was admitted for further evaluation of hyperglycemia. Laboratory tests were negative for a urinary tract infection; however, results revealed elevated serum glucose and hemoglobin A1C. She was diagnosed with new-onset diabetes mellitus and started on insulin therapy. Management of her diabetes was complicated due to advanced neurodegenerative symptoms related to FRDA. An individualized treatment plan and coordination of care with her home facility were essential for managing her diabetes.

Mite and Bed Bug Infections.

Patients with suspected bites or skin rashes regularly present to their primary care physician. Common mite infections encountered in the primary care office include scabies, chiggers, grain itch, and allergic responses from dust mites. In fact, scabies is one of the 50 most prevalent diseases worldwide. Bed bugs are also becoming increasingly common, living in dark crevices, such as mattresses, feeding at night, and causing a maculopapular immune mediated allergic skin response in humans. Proper identification of the mite or bed bug is essential to guide treatment and eradication.

Surveying Applicants to Improve the Family Medicine Residency Interview Day.

INTRODUCTION: The diversity of family medicine residency programs across the country makes a generalized assessment of applicant preferences and experiences regarding the interview experience difficult. As such, there have been few publications in recent years relating to interview trail trends and modification of the interview day process to meet the needs of applicants. The purpose of this project was to identify applicant preferences and trends among applicants interviewing at Penn State Health's Milton S. Hershey Medical Center during the 2014-2015 and 2015-2016 application cycles. METHODS: Applicants completed a voluntary, anonymous, 16-question multiple-choice survey during the interview day. Questions explored the preinterview dinner, interview day, and postinterview day communication methods. RESULTS: In total, 67 surveys were collected from 68 eligible candidates (98.5%) in 2014-2015, and 65 surveys from 65 eligible candidates in 2015-2016 (100%) for a total of 132 participants. Applicant preferences focused on use of electronic communication and the importance of interviewing with both the program director and a current resident. Interview day trends experienced by those surveyed emphasized the inclusion of spouses/significant others, program support of hotel costs, frequency of applicant preinterview dinners, and the lack of emphasis on second-look visits. CONCLUSION: This study highlights how the utilization of applicant surveys during the interview day may allow family medicine programs to identify trends occurring on the interview trail, while developing an interview day agenda that meets the desires of the applicants the program attracts.