IHuman Case Study 60-Year-Old Male with Painful Rash – NRNP 6512 Week 4 Differential Diagnosis And Clinical Reasoning
IHuman Case Study 60-Year-Old Male with Painful Rash – NRNP 6512 Week 4 Differential Diagnosis And Clinical Reasoning
Patient Demographics
• Name: Mr. James Carter
• Age: 60 years
• Sex: Male
• Height: 6’1’’ (185 cm)
• Weight: 210 lbs (95.5 kg)
• BMI: 27.7 (Overweight)
• Reason for Encounter: Painful rash
Subjective
Chief Complaint:
“I’ve got this painful rash on the left side of my chest that started a few days ago. It burns and it’s getting worse.”
History of Present Illness (HPI):
Mr. Carter is a 60-year-old male presenting with a 4-day history of a painful rash. He reports that the symptoms began as a tingling, burning sensation on the left side of his chest and back, followed within 24–48 hours by the appearance of red patches with fluid-filled blisters. The rash has continued to spread along the same line on his body.
He describes the pain as sharp, stabbing, and burning, rated 8/10, and worse when clothing touches the skin. He denies fevers, chills, sweats, sore throat, cough, chest pain, or shortness of breath.
He has not started any new medications, foods, or detergents recently. No one else at home has a rash. He had chickenpox as a child.
The rash has made it difficult for him to sleep. He feels “on edge” and “irritable” from the discomfort.
Past Medical History:
• Hypertension × 12 years
• Hyperlipidemia × 8 years
• Seasonal allergies
Past Surgical History:
• Appendectomy at age 22
• Arthroscopic knee surgery at age 50
Family History:
• Father: deceased, myocardial infarction at 72
• Mother: alive, hypertension
• Brother: Type 2 diabetes
• No known autoimmune or dermatologic disorders in family
Social History:
• Retired construction worker
• Married, lives with wife
• Former smoker (20 pack-years, quit 10 yrs ago)
• Drinks 1–2 beers weekly
• Denies illicit drug use
• Walks for exercise 3x per week, but activity limited lately due to pain
• Diet: reports frequent fried food, limited vegetables, high in red meat
Medications:
• Lisinopril 20 mg PO daily
• Atorvastatin 40 mg PO nightly
• Aspirin 81 mg PO daily
Allergies:
• No known drug allergies
Review of Systems (ROS):
• General: No fever, chills, fatigue, or weight loss
• Skin: Painful blistering rash on left chest/back, burning pain, sensitivity to
touch
• HEENT: No vision changes, no sore throat, no ear pain
• Cardiac: No palpitations, chest pain, or edema
• Respiratory: No cough, SOB, or wheezing
• GI: No nausea, vomiting, diarrhea, or abdominal pain
• GU: No dysuria or urinary frequency
• MSK: No joint swelling, stiffness, or muscle weakness
• Neuro: Tingling/burning in rash area, denies headaches, weakness, dizziness,
or syncope
• Psych: Reports anxiety, irritability, and trouble sleeping due to pain
Objective
Vital Signs:
• Temp: 98.6°F (37°C)
• HR: 82 bpm
• BP: 138/84 mmHg
• RR: 16/min
• O₂ Sat: 98% RA
General: Alert, oriented, appears uncomfortable, guarding left chest area.
Skin:
• Linear clusters of erythematous vesicular lesions on an erythematous
base, distributed along the left T5–T6 dermatome (mid-back to anterior
chest).
• Some vesicles are intact, others crusted.
• Lesions are tender, with surrounding hyperesthesia.
• Rash does not cross midline.
HEENT: Normal, no conjunctivitis or oral lesions.
Cardiac: RRR, S1/S2 normal, no murmurs or gallops.
Respiratory: Lungs clear to auscultation bilaterally, no wheezes/rhonchi.
Abdomen: Soft, non-tender, no hepatosplenomegaly.
Neuro: Strength and reflexes normal in upper and lower extremities. Cranial nerves II–XII intact. Hyperesthesia and burning pain localized to affected dermatome.
Lymph nodes: No cervical, axillary, or inguinal adenopathy.