Journal of Urgent Care Medicine

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Images in Urgent Care Challenge
   November 10, 2008   Presentation
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The patient is a 56-year-old man who emigrated from Mexico to Texas two months ago. He first presented about two weeks ago with a dry cough, chest pain, fevers, and night sweats. Chest x-ray showed a focal consolidation. He had received BCG vaccination as a child, so a PPD was not placed. He was started on isoniazid, rifampin, and ethambutol for tuberculosis.

Now, he presents complaining of the same symptoms, plus a rash that erupted approximately one week ago, after starting the medications about a week prior.

On examination, you find he now has widely distributed dark red plaques that he states are very itchy.

You order another chest x-ray, which looks the same as the previous one.

View the images and consider what your next steps would be.

Click on the button below to see the resolution of the case.
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