The Clinical Problem Solvers Episode 416 – Clinical Unknown Series with Dr. Vinicius de Sousa
Aug 29, 2025
A middle-aged man with a troubling bilateral rash takes center stage in a captivating clinical analysis. The discussion dives deep into the complexities of diagnosing dermatological conditions, highlighting potential small vessel vasculitis. Listeners will appreciate the emphasis on systematic approaches to patient evaluation, the nitty-gritty of lab findings, and how important differential diagnoses can be. Alongside serious medical talk, the light-hearted vibe of music preferences adds a unique flavor, making learning both engaging and informative.
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Palpable Purpura Suggests Vasculitis
- Palpable purpura strongly points to small-vessel vasculitis rather than simple skin infection.
- Characterize rashes (petechial vs blistering vs urticarial) to pick the right diagnostic schema.
Use IMAID To Organize Rash Causes
- Use broad diagnostic schemas like IMAID to organize rash differentials: Infection, Malignancy, Autoimmune, Injury/Drugs, and Degenerative/endocrine.
- Prioritize targeted labs and history (fever, meds, systemic signs) to narrow the cause quickly.
Patient Linked Rash To A Rusty-Screw Wound
- The patient recalled a puncture wound from a rusty screw before rash onset and initially improved with cephalexin.
- However, the eruption recurred and later spread to the contralateral leg and arms despite multiple antibiotic courses.