Worst Case of Misdiagnosed Acne Ever

We had a young boy that came into the emergency room with his mom. He was about seventeen, and his mom reported he had a bad case of acne. He had been put into a trauma room, and a nurse was sent to check him in. Before nurse Dan went into the room, he pulled me aside and showed me the complaint.

I asked, “Why would someone bring their child into the ER for acne?”

Nurse Dan replied, “I bet this will be a five-minute visit or less. One of the doctors will explain that acne is not life-threatening and can be taken care of through topical treatment, and if it gets bad, they can see a dermatologist.”

I said, “There’s a full moon out. I bet this is going to be a bit harder than that.”

He walked away and added, “You just jinked it.”

Ten minutes later, I heard someone screaming down the hall. I left the nursing station and found a woman hurrying around the hospital calling for a doctor.

“Can I help you?” I asked.

“Are you a doctor?”

“No. But I can go find one. Tell me what is going on.”

The mom explained that she was really concerned about her son. The nurse that had been in the room was asking too many questions, and the doctor had yet to arrive. She left the room and began searching for someone. Suddenly, she started jogging ahead of me, screaming, “Help. I need a doctor. My son is dying.”

I followed her, trying to calm her. When I caught up to her, I said, “Listen. I know where the doctor is. I’ll bring you to your room and go find them.”

As we walked back to her son’s room, she explained that he had severe acne on his arms. It had been getting worse the last few months. The acne on his face and back was far less noticeable. She reported that the same thing happened to one of his cousins. He had these sores on his arms, and when she had asked him, he had said it was acne. Another cousin on the opposite side of the family had required more advanced acne treatment. She had started looking up acne treatments online and heard of something called Accutane.

“I just know that if we can start him on that medication today, he will do better.”

We arrived at her son’s room just as Nurse Dan stepped out. I said, “This is Mrs. Schaffer, and she’s the mother of your patient. She’s really worried about her son’s acne, and she’s requesting that he starts treatment right away.”

“I’m not sure that we are dealing with acne. We will likely need to run some tests and see if something more is going on.”

“What? Of course, it’s acne. My son’s cousin had the same thing. Maybe this is just the worst case of acne you’ve ever seen, and you aren’t sure how to treat it.” Mrs. Chaffer added, “I’m telling you, if you start Accutane, he’ll start feeling better in no time.”

I watched as Nurse Dan’s eyes enlarged, and a look of surprise crossed his face. He said, “Accutane is a very special medication however, it has lots of side effects. Treatment is the doctor’s decision. If Accutane is approved, we’ll need to run several blood tests to confirm that he’s a candidate.”

“Thank you for listening to me,” she said.

“No problem.”

I said, “Thanks Dan. I’ll drop off Mrs. Schaffer.”

As I entered the room, I was shocked to see the condition of Mrs. Schaffer’s son. He was shaking, pale, and covered in clothing. Despite the layers of clothing, he was shivering. His eyes were closed, and he was stuffed under the blankets. The worse part was the extremely foul smell in the room, like decaying skin.

I asked, “When did the acne start?”

“About three or four months ago.”

“He looks like he’s freezing. Have we checked a temperature?”

“The first nurse said it was like one-hundred and three degrees.”

“That’s pretty elevated.”

“It’s probably from the sunburn. He hasn’t reacted as well as I was hoping to the sunlight. I thought he was made of stronger stuff.”

“What do you mean?”

“One of the recommended treatments for acne is sunlight. It’s supposed to help with things like eczema and acne.”

“How much sun are we talking about?”

Mrs. Chaffer pulled up the arm sleeves of his son, and the redness was frightening. But there were also large sores on his arms that looked nothing like acne.

“What else have you tried?” I asked hesitantly.

Mrs. Schaffer sat in a chair and added, “After some topical creams that the first doctor gave me, we tried toothpaste and urine mixed together. We were about to try bleach.”

“You’re kidding.”

“No. The Urea in urine plus toothpaste is really supposed to be anti-acne with antioxidants.”

“I don’t think that is how it works.”

She stared directly at me and said, “I hope this hospital is willing to try holistic treatments in addition to Accutane.”

“Urine is not holistic, and toothpaste really is effective inside the mouth.”

“Show how much you know.”

“Well. I will go ask the doctor to consider some holistic measures. But you still want Accutane, right?”

“Yes. My sister said that will help keep acne away permanently.”

I left and found Nurse Dan already talking with Doctor Sydney. I joined the conversation just as Dan said, “His arms have nothing to do with acne. He has a serious infection, and I’m worried his mother is making things worse.”

I added, “I’m also concerned. His mother told me that they put urine and toothpaste on his arms to help with the acne. After that, they’ve been using sunlight. He has a terrible sunburn. They want holistic options.”

Dr. Sydney said, “Thanks for warning me. Let’s go take a look.”

Back in the trauma room, Dr. Sydney was doing her exam. Her poker face was much better than ours. Now that his shirt was off, there were significant burns on the chest, back, and arms. “How did he get so burned?” asked Dr. Sydney.

“I took him to a tanning booth and uncovered only his arms, chest, and back. I think that once his skin peels, it will help with his acne.”

“It won’t,” said Dr. Sydney flatly. “This is a much more serious medical issue than acne. And although that might be an issue, there are more important things that we need to address.”

Mrs. Schaffer stood and began gathering her things. “It is clear, after talking with the charge nurse, it was obvious that natural treatment isn’t possible in this hospital. I think it is time for us to leave.”

Dr. Sydney said, “That’s not a good idea. Your son is very sick, and if you leave, that will be child endangerment. I’ll have to call the police.”

“Why would you?”

“He is extremely sick. If he doesn’t get treatment soon, it could become life-threatening.”

“What are you talking about?”

“You see, your son can’t control his body temperature right now because of this infection and the sunburn. We need to get some lab work but start an IV and give him some general antibiotics until we know better. I think he’ll feel better if we get him started on some treatment. If we don’t, he’s going to get much worse.”

“Fine,” Mrs. Schaffer said.

Nurse Dan started an IV and started some fluids. Mrs. Schaffer’s son was given some oral antibiotics, but he struggled with swallowing. In total, he has seven large boils on both arms. He had some minimal acne on his face, chest, and back. This acne would be considered a normal severity for a teenage boy.

The lab work returned a few hours later, but Mrs. Schaffer’s son was only feeling marginally better. He was no longer shaking, but he was still extremely dehydrated. The fluid had helped him to urinate, and we tested that as well.

Dr. Sydney entered the trauma room and said, “Well…we’re definitely not dealing with acne. Accutane would be unhelpful in this case.”

“What are you talking about?” She pointed to her son’s arms and said, “Can’t you see this cystic acne?”

Dr. Sydney pulled out a tablet and brought up pictures of acne, especially on the arms. Next, she showed her what cystic acne looks like. Me, Nurse Dan, and another nurse came into the room.

Mrs. Shaffer replied, “That’s not what I found on the internet.”

“Additionally,” continued Dr. Sydney, “your son tested positive for heroin. He has been using it for a while. Those sores on his arms are from shooting up.”

“Ah…no. My son doesn’t do drugs.”

“That’s not what the blood work shows. And that’s not the worst thing. By not properly treating the injection areas, these sites are now seriously infected. Your son will need IV antibiotics for the next few days. Additionally, we will need to watch his heart because it looks like he is at risk for sepsis.”

“How long are we talking?”

“He’s going to be in the hospital for a few days.”

Dr. Sydney moved closer to her son and took a seat. She took out several needles with medications and a scalpel.

“What are you doing?”

“We need to drain these abscesses. Treatment will become far more successful if we do this.”

The next hour was spent cutting into each abscess on both arms. Some were small, but three were gigantic. The smell was horrible, and Mrs. Schaffer left after just a few openings. There was so much purulent discharge that even I was impressed. This was the worst case of fake acne I had ever seen.

The next day, Mrs. Schaffer told me that she spoke with her sister-in-law, who confronted her son’s cousin, and he admitted that he had shot up with him. They had been doing heroin together for three months.

 

 

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