Acute Urticarial Rash in Elderly Patient Following Dried Fig Consumption

Case at a Glance

A 75-year-old male presented with acute onset of erythematous, raised patches on bilateral forearms and subsequent generalized distribution following consumption of dried figs. Patient was concurrently on deflazacort therapy for underlying respiratory symptoms.

Patient's Story

The patient, a 75-year-old male with no known food allergies, consumed dried figs after an extended period of avoidance. Several hours post-consumption, he developed pruritic, erythematous, raised lesions initially localized to bilateral forearms. The rash subsequently progressed to involve the entire body surface. The patient experienced significant discomfort and distress from the intense pruritus. Notably, he denied facial edema, lip swelling, dyspnea, or gastrointestinal symptoms.

Initial Assessment

Physical examination revealed widespread urticarial lesions characterized by raised, irregular, erythematous patches with well-demarcated borders. The rash demonstrated a generalized distribution pattern. Vital signs remained stable with no signs of anaphylaxis. Patient was alert and oriented with no respiratory distress or hemodynamic compromise.

The Diagnostic Journey

Given the temporal relationship between dried fig consumption and symptom onset, along with the characteristic morphology of the lesions, a diagnosis of acute urticaria secondary to food allergen exposure was considered. The patient's concurrent use of deflazacort (prescribed for chest pain and respiratory symptoms) was noted as a potential confounding factor. No additional diagnostic testing was immediately required given the clinical presentation.

Final Diagnosis

Acute generalized urticaria secondary to dried fig allergen exposure

Treatment Plan

Immediate management focused on antihistamine therapy and symptomatic relief. The patient was advised to discontinue consumption of figs and related fruits. Close monitoring for signs of anaphylaxis was implemented. Consideration was given to the patient's existing deflazacort therapy and its potential interaction with the allergic response.

Outcome and Follow-up

Patient education regarding food allergen avoidance was provided, with specific emphasis on reading food labels and avoiding cross-contamination. Follow-up was scheduled to monitor resolution of symptoms and discuss potential allergy testing if symptoms persisted or recurred. The underlying condition requiring deflazacort therapy warranted separate evaluation and management.