Time for a little game. I will provide an excerpt from a case. I will not provide the link until tomorrow. You can try to figure it out. Feel free to post your guesses in the comments section. The case is quite instructive.
My patient was a 25-year-old woman who came to me, a dermatologist, because her skin had been burning for the last nine days. She described it as feeling like a sunburn, although she had not been in the sun. The sensation began on her thighs and spread to her entire body. She was aware of it all the time, and found that she felt worse when her clothing touched her skin. The discomfort persisted throughout the day. She had not been sick recently and took no medications except for some vitamins.
On examination, the texture, color and temperature of her skin were normal, and there was no evidence of scratching or of any parasites. There are a number of disorders that can be accompanied by skin discomfort without visible signs. The sensation is usually one of itching, although if itching is severe enough, it can feel like burning. Those diseases include hepatitis, leukemia, diabetes, diminished kidney function and almost any cancer if it is advanced enough.
I had blood drawn for the routine tests for the first four of those ailments, but this young woman appeared quite healthy, and I doubted that the tests would turn up anything.
In the absence of anything else, I wondered about the possibility of some sort of poisoning. She worked in an office and had no occupational exposure to toxins. She did not garden and had not been exposed to insecticides, and she had no hobbies that would have put her at risk.
On further questioning, she told me that she had a roommate who had a similar symptom, but that it lasted only a day or two. Because of the slight possibility that both she and her roommate had been exposed to something that caused the burning skin, I asked her what kind of place she lived in. She said she lived in an apartment in a coach house.
So that is your challenge for the next 24 hours. I would not have figured this one out!
