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Thank you for the detailed history. Is it possible to forward a photograph or two?
The blotchy rash quitens down and we think she is getting better, but then it erupts again and moves around. The blotches get bigger and are an angry red around the edges - they get bigger (rather like a drop of ink on blotting paper - the drop soaks outwards).
At the moment the rash is quiet and I am hoping it will not erupt again, but if/when it does I will take a photo. She is still ever so weak and spends most of the time asleep or dozing. The antihistamines are probably making her drowsy, and her body probably wants to sleep as it needs to fight the toxins and to repair everything.
A few suggestions before seeing the photo(s). 1) It is easy to tell whether strep has a role by doing a blood test called an ASO titer. If this is normal, then the problem would not be due to strep. It is possible the ER doctor ordered that blood test and that is why he called you back with the diagnosis of Erythema Marginatum. 2) She should have an EPI pen, two actually. One for the home and one in her purse. 3) A dermatologist would be most appropriate. Toxicologists generally are usually called in to investigate murders, and/or are Phd's working in labs. Since she has a skin problem, she should be seen by a dermatologist. 4) If the ASO titer is normal, I would consider something called Sweet's syndrome as your description seems to fit this. Patients are also quite ill with this. It responds to steroids but may recur. 5) A drug allergy is another possibility if she is taking medications.
Just some thoughts, but a picture or two will help more.
Some doctors and many patients do not realize that many drug allergies develop, sometimes after years of taking the medication. Thus, if she has been on a medication for years, does not rule out a drug eruption.
Keep a food diary and see if there is a certain food that may be triggering the problem. Often, this can be a preservative.
I would highly recommend a dermatologist. Last week, I had a long talk with an old English friend, who tells me that is not such an easy thing in the NHS ( by the way, his brother is an English Olympic hero...and an extremely nice person). But I think it would be important to do so.
I have office hours and must depart.
Please let me know of further questions. I check in periodically.
I just looked up Sweets Syndrome and looked at the images - definititely not what my wife has. The pictures of Sweets syndrome had a raised angry spot in the middle of the blotch. My wife had blotches that were raised and angry red around the edges. The pictures on the internet of Erythema Marginatum are what my wife looked like. Getting to see a Dermatologist is difficult - August on the NHS or June privately - by then the rash will have cleared up (I hope)
My wife and I are not faddy eaters and eat practically anything and have never had a food allergy. When all this started we were eating marinaded chicken with salad. When we looked at the ingredients list there was nothing unusual - chicken, tomatoes, parmesan cheese, garlic, oregano, rosemary, thyme. No nuts, shellfish, sesame or other common allergens.
At the hospital A&E they took some routine blood samples, but I don't think they tested for StrepA . It was only later that the doctor looked at images of rashes and thought that Erythema Marginatum was the closest to my wife's rash and he phoned us to go back and pick up a course of antibiotic tablets. He thought the Strep A would have already gone, but took a throat swab which came back negative.
I don't know whether it is getting better with time, or due to the antibiotics or antihistamines. The big blotches have gone down and are bluish (a bit like a bruise) There are still some angry red spots around the edges but not many. Her feet and ankles are a bit swollen.
If her legs are swelling and these areas look violaceous ( bruise-like) and angry, I would consider some type of vasculitis. This would respond to steroids and might resolve for awhile. Do you know if the A&E doctor did a sedimentation rate. This is nearly always elevated with a vasculitis.
I have taken some photos - how do I send them to you?
Gret. Click on the paper clip icon and upload. This does not work with Google Chrome or Safari, though in which case you can send through a photosharing site such as Picasa or Photobucket.
If you are having trouble sending the photos, the easiest way is through e mail goint to***@******.*** and send to my attention. This is a slower, but nonetheless reliable method. You will be informed when they are received.
The rash has settled down a lot - this photo shows the bluish/purple blotches left behind. They were raised, red and angry around the edges, and spreading outwards, leaving the central area bluish/purple as in the photo. There are still some red spots but nowhere near as bad as before. The rash affected almost everywhere including the palms of her hands and the soles of her feet (but not her face)
The first photo shows the blotches on her feet settling down but still sollen and bluish.
The second photo is the next day - the swelling and bluish colour have gone down a bit.
I am afraid these photos may not help very much as the blotchy rash has settled down a lot. I don't know whether this is due to the antihistamines or whether her body has managed to break down or get rid of the toxins.
I will see if her Doctor can take a blood sample to test for Strep A antigens ie to see if she has had a recent Strep A infection.
Is it possible that the chicken had a Strep A infection and was full of toxins??. ie the chicken caused an allergic reaction but it was the Strep A toxins that caused it not the chicken itself.
Incidentally there is an outbreak (double the number of cases) here in the UK of Strep A/Scarlet Fever
I discussed your case ( and showed the pictures) to one of my colleagues tonight. We thought that the best approach would be to perform a biopsy. To us, the pictures look more like hives. I can't say she did not have Erythema Marginatum at one point, but we agreed that the pictures we saw did not suggest this. If she is having swelling in her feet and some of the symptoms you describe, I think her physician should investigate the possibility of urticarial vasculitis. I think we all agree that an ASO titer should be done.
I am not a vet ( though my doctor wants to be one), so I would have no idea whether chickens can develop strep. If so, I am unaware that they can transfer strep to humans, by consumption of strep or its exotoxins.
I would suggest her physician take a sed rate. A normal one, especially a low one, would strongly mitigate against the urticarial vasculitis hypothesis.
Her physician should also consider hereditary angioedema, especially if she had any abdominal pain or other GI symptoms.
Let me know what you think.
We have just been to see our Doctor. More steroids and anti-histamines. Can't do blood test today (Friday - Poet's Day)
Have to wait till Monday for blood test.
OK. Keep me informed. I would also recommend a skin biopsy.
Waiting for blood test results.
Course of steroids finished. Still taking anti-histamines but now the non-drowsy type.
Rash has gone down a lot but still some red spots and still a bit itchy Food is tasting normal again and appetite has returned. More active now but get tired easily. (It is now 16 days since it all started )
Blood test shows no sign of Strep A - just high platelets and white blood cells - another blood test in 2 weeks
Thank you for the follow up. I am glad the negative Strep test confirmed out impression that this was not Erythema Marginatum. I still think an SPEP ) Serum Protein Electrophoresis) and at least a sedimentation rate would be of value.