Circular Facial Lesions with Systemic Symptoms in a 37-Year-Old Female

Case at a Glance

A 37-year-old female presents with a 2-month history of circular facial lesions accompanied by systemic symptoms including full-body rash and gastrointestinal disturbance. The patient has a concurrent E. coli infection and a family member with similar skin manifestations.

Patient's Story

The patient is a 37-year-old female (height 5'8", weight 190 lbs) with a medical history of migraines who developed an unexplained systemic illness two months prior to presentation. She reports the onset of multiple circular lesions on her face, initially appearing as red spots on her nose that evolved to become skin-colored to light pink circular patches with distinct borders. Some lesions initially contained central pustules or vesicles surrounded by an erythematous ring. The patient also developed a generalized body rash and diarrhea. Notably, her child developed similar skin lesions, suggesting possible infectious or environmental etiology.

Initial Assessment

Physical examination revealed multiple circular lesions on the face, including the nasal tip, cheek, and lower lip. The lesions were described as having a different texture compared to surrounding normal skin, with well-defined borders and occasional small pustules within the circles. The patient appeared systemically unwell with associated gastrointestinal symptoms.

The Diagnostic Journey

Laboratory testing was initiated to investigate the systemic illness. Stool culture was positive for E. coli infection, which may explain the gastrointestinal symptoms. However, the relationship between the bacterial infection and the distinctive facial lesions remained unclear. The unusual morphology of the lesions, combined with the familial occurrence and systemic symptoms, prompted consideration of various differential diagnoses including infectious, inflammatory, or immunologic conditions.

Final Diagnosis

Pending dermatological evaluation. Working diagnosis includes possible infectious dermatosis with concurrent E. coli gastroenteritis. Differential considerations include bacterial skin infection, viral exanthem, or inflammatory dermatosis.

Treatment Plan

1. Treat confirmed E. coli infection with appropriate antimicrobial therapy
2. Symptomatic management of gastrointestinal symptoms
3. Dermatology consultation scheduled for comprehensive evaluation of facial lesions
4. Consider additional infectious disease workup if lesions progress
5. Family member evaluation recommended given similar presentation

Outcome and Follow-up

Patient awaiting dermatology consultation scheduled within one month. Clinical photography documented for monitoring lesion progression. Family screening initiated due to similar presentation in household contact. Further diagnostic workup pending specialist evaluation to determine definitive diagnosis and appropriate targeted therapy.