11.11.2008

The Case Was Quizzical...

...until we did a physical.

The other day in clinic a 24 year old male presented with a two day history of right-sided scrotal pain and a one week history of malaise and lingering symptoms of an upper respiratory infection. I was working him up for two completely different problems. Until we performed the physical exam. Scrotal exam was unremarkable. EENT exam was unremarkable. Resp exam was non-contributory. Then to be thorough, we told the patient we would do a rectal exam to rule out a prostatis. The minute the guy turned around, the doc and I both looked at each other, our eyes twinkling with the common understanding that our case was solved. We had a diagnosis. Unbeknownst to the patient, he had a classic unilateral herpetic rash along the S1-S2 dermatome on his backside where the full moon shines. Bingo! That explained the URI symptoms as a prodrome and explained his scrotal pain. The patient had Shingles.

This wasn't just a zebra case...it was a red zebra.

5 comments:

LGH said...

Holy, holy cow; a 24 year old had shingles! That is just downright scary! do you think it is a good idea for older folk to get the shingles shot?

Dianne said...

Great story, patients give us constant reminders about the importance of being thorough! See you in a few days, Dianne

Paula said...

Nice job. Most people would not have looked at the back side. You put a smile on my face.

Anonymous said...

.....would not have thought of shingles! At 24, I would have had to think about the rectal exam. You are so stinking smart!!
Bridget

Joanne said...

Excellent - you'll do well in the Zebra class.

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