Rash on trunk, palms and soles...........circular rash

[Timaca]

Hi~

Ten years ago, I had a bite on my finger which turned into an open necrosing wound.  I never saw or felt what bit me, but it became a nasty wound.  It became infected and I took some erythromycin for it.  A week AFTER finishing the erthyromycin, I developed a rash on the trunk of my body and on my palms and soles.  It was hard to walk or hold a pencil.  I also didn't feel well.

The bite and rash healed, and I was in very good health for ten years.

I got a steroid shot in the knee in the fall of 2003 and fell apart 3 weeks after that with bizarre symptoms.  It took a year and a half and many doctors before I was finally diagnosed with Lyme disease at Columbia University Medical Center.  A neurologist at Cornell University also confirmed the diagnosis.  (Note:  I live in the SW)

It is likely that the steroid shot activated latent lyme in my body....possibly from the bite 10 years ago.  

I have been on antibiotic treatment since April of 2005, and I have gotten significant improvement.  However, due to complications of treatment, the antibiotics were suspended for 2 months, at which time the lyme symptoms began returning.

First question...I understand that rickettsia infections can cause a rash on palms and soles and that it is best treated with doxycycline.   Correct?   Any other organisms that can cause a trunk/palm/sole rash??  

I tend to think that the rash ten years ago was not associated with the erythromycin, since it appeared a week after I finished the drug.  Most drug allergies occur while on the drug.  Correct?

It has been an interesting observation on my part to note that 10-12 days after the start of an antibiotic regime, I have a "significant issue" which is most likely a Jarisch-herxheimer like response to the antibiotic.  (See www.columbia-lyme.org  at "key terms" for more info on a J-H reaction)

My most recent J-H reaction to my first dose of IM bicillin LA landed me in the ER Saturday with signicant tachycardia.  This was 10 days after the IM bicillin LA shot.   Today I noticed on the trunk of my body a circular rash.  About the size of the circle formed when an index finger and thumb touch each other.  It is a slightly raised rash...but so far, just the outer edge is red with any color.    

This is not a typical bull's eye rash...at least not yet, but I'm curious as to what this might be.   A lyme rash?   Other ideas?  

Lyme disease is horrible.   I went from doing 17 mile races over 13,000 foot mountain passes to having to sit on a stool to make dinner.   When I would stand, the wall would have to hold me up.  

Thanks in advance for your input.....Timaca

[Alan Rockoff, MD]

You have a pretty exotic condition (steroid-triggered Lyme Disease?) with which I frankly have no clinical experience.  Palm rashes include secondary syphilis and erythema multiforme.  Rickettisal diseases usually make people acutely ill.  I have no idea whether any of these makes the slightest sense in your context.

You are correct about drug allergies: they at least start while on the drug, and eryhtromycin rarely causes them.

I really don't understand why you're trying to diagnose yourself on the internet, though.  You need to consult a physician in person, preferably the ones who diagnosed you in the first place.  Whatever this is, it will require sophisticated examination and testing to puzzle out.

Thanks.

Dr. Rockoff

[Timaca]

Thank you for your quick, kind and honest response.  

I do have several doctors following my care.  A Lyme disease specialist in NY state, my local PCP, my local cardiologist, and today I will be seeing a dermatologist to have the circular rash cultured.  

I appreciate this website.

Timaca

[Alan Rockoff, MD]

Thanks.  Good luck.

Dr. Rockoff

[susannaj]

Hi-  I have just been trying to research my palm, soles, and trunk rash and came across your discussion.  I have had this rash six or seven times in the past six years.  It is completely mystifying my general practicioner, dermetologist, and most recently, my allergist.  It looks like poison ivy, except more uniform and even with no "point of contact" visible.  It usually shows up first on my hands, or maybe I just notice it there first..but this last time it was distinctly on my stomach first.  It does not show up in any particular season, or when I eat any specific food.  My best guess was that it was a sensitivity to new clothing- only because that is the only thing that I did sometime around every time I've gotten this.  Although, I have also tried on new clothes and not hads any reactions many times.  I just had extensive allergy testing and the only abnormal thing that showed up was a nickel allergy.  I don't wear any silver or funny metal jewelry, only a wedding ring and that's new last year.  I have had to go on prednizone everytime this has happened and it does work well, except this last time it made me crazy.  I would like to have this resolved before my husband and I decide to have kids so that I don't have to take such a serious drug when I'm pregnant, or suffer with a dibillitating rash.  Any thoughts, leads, or clues would be very much appreciated.

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