Age: 31.0
Sex: F
Vaccine: COVID19
Symptoms: Rash pustular, Tachycardia
Clinical narrative: Patient reports receiving COVID booster vaccine on 2/27, develop fatigue and rash on her legs on 2/28.  3/2  presented to ED and given steroids, benadryl, famotidine, atarax 3/2-3/3 rash worsened and spread up her legs, groin, abdomen, back, arms, and neck. Developed diffuse abdominal pain with nausea, dyspnea and dysuria. No cough or chest pain. No fevers.  3/4 -3/6 ED to hospital admission Presented again to ED Review of Systems  Constitutional: Negative for chills and fever.  HENT: Negative for congestion and sore throat.   Eyes: Negative for pain.  Respiratory: Positive for shortness of breath. Negative for cough.   Cardiovascular: Negative for chest pain.  Gastrointestinal: Positive for abdominal pain and nausea. Negative for constipation and diarrhea.  Genitourinary: Positive for dysuria. Negative for difficulty urinating.  Musculoskeletal: Negative for neck pain.  Skin: Positive for rash.  Allergic/Immunologic: Negative for immunocompromised state.  Neurological: Negative for headaches.  Hematological: Does not bruise/bleed easily.  Physical Exam Vitals reviewed.  Constitutional:      General: She is not in acute distress.    Appearance: Normal appearance. She is not ill-appearing, toxic-appearing or diaphoretic.  HENT:     Head: Normocephalic and atraumatic.  Eyes:     Extraocular Movements: Extraocular movements intact.     Conjunctiva/sclera: Conjunctivae normal.     Pupils: Pupils are equal, round, and reactive to light.  Cardiovascular:     Rate and Rhythm: Regular rhythm. Tachycardia present.     Pulses: Normal pulses.     Heart sounds: Normal heart sounds. No murmur heard.   No friction rub. No gallop.  Pulmonary:     Effort: Pulmonary effort is normal.     Breath sounds: Normal breath sounds. No wheezing, rhonchi or rales.  Abdominal:     General: Abdomen is flat. There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is abdominal tenderness (diffusely). There is no guarding.  Musculoskeletal:        General: Normal range of motion.     Cervical back: Normal range of motion.     Right lower leg: No edema.     Left lower leg: No edema.  Skin:    General: Skin is warm and dry.     Capillary Refill: Capillary refill takes less than 2 seconds.     Findings: Rash present.     Comments: Diffuse pustular rash involving entire extremities, abdomen, back, groin, with surrounding erythematous skin, no ulceration, no sloughing, blisters, no oral mucosa or palms or soles involvement.   Neurological:     General: No focal deficit present.     Mental Status: She is alert and oriented to person, place, and time.  Psychiatric:        Mood and Affect: Mood normal.        Behavior: Behavior normal.  Pt given prednisone 1mg/kg daily for AGEP Pt was dc'd w/ prescriptions for Prednisone 40mg, Triamcinolone 0.1% ointment (1 lb jar) and Hydrocortisone 2.5% cream.  3/9 pt seen for f/u predniosone decreased to 20mg PO daily x4 days, then 10mg daily x4 days then stop.  Pt rash improving but not yet resolved 3/29 Pt rash was having a flare.  Seen 3/30. Restart prednisone: 20 mg once daily x 1 week, 15 mg once daily x 1 week, 10 mg once daily x 1 week, 5 mg once daily x 1 week then stop - Continue triamcinolone 0.1% oint BID to AA on trunk and extremitise, do not apply to face, neck, armpit, or groin, SE reviewed. - Continue hydrocortisone 2.5% cream BID to AA on face, groin, axilla, SE reviewed - Pt instructed to call us immediately if skin starts to flare and go back up on prednisone dose to last dose before flare.