Abstract
IntroductionAcute erythema and oedema of the genitalia is an alarming complaint for any patient. Diagnosis can be complicated by atypical presentation and the use of concurrent immuno-modulatory drugs.Case presentationWe present a case report of a man on anti-TNF therapy for rheumatoid arthritis presenting with an acutely red, swollen, non-tender penis and scrotum presumed to be infective. The discovery of erythematous plaques in both antecubital fossae alerted the clinicians to consider alternative dermatological diagnoses.ConclusionThe accepted adjuncts to confirming or excluding infectious aetiology were complicated by the use of immuno-modulatory medication in this case. This patient's unusual presentation may have been associated with and was complicated by the use of etanercept. The case illustrates the need to consider other diagnoses and obtain appropriate advice when the clinical course is not progressing as anticipated.
Highlights
Acute erythema and oedema of the genitalia is an alarming complaint for any patient
Resolution of symptoms has been reported within 72 hours with empirical treatment of scrotal support and elevation, antibiotics and antihistamines [5,6]
We describe an acute presentation of painless, erythematous, swollen genitallia associated with a simultaneous dermatological reaction in both antecubital fossae in a patient taking methotrexate and etanercept for rheumatoid arthritis
Summary
A definitive diagnosis was not reached in this case. It illustrates the need to revisit the history and examination when the clinical course does not correlate with the expected response and remain open to alternative diagnoses. It illustrates the need to involve additional specialties when dealing with specialist medication. IFmigaugereof2ante-cubital fossa rash Image of ante-cubital fossa rash. Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal
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