unilateral, they must be distinguished from early herpes zoster infection,
especially if vesicles are present. (d)Erysipelas with bilateral involvement
may be confused with the malar rash of SLE. The malar or “butterfly” rash
of SLE consists of erythema on the medial cheeks and across the bridge of
the nose. Women of childbearing age comprise 90% of affected individuals,
and clinical presentation generally includes multisystem involvement. (e)
Erysipelas remains a clinical diagnosis. Skin biopsy is rarely necessary and
often unhelpful.
178.The answer is d.(Centor et al, pp 239-246.)The patient has a mod-
ifiedCentor score of 2(history of fever, tender adenopathy, no cough,
age > 45 years). TheCentor criteria,seen below, is used for predicting
streptococcal pharyngitisand whether or not to treat the patient with
antibiotics.
Fever Answers 199Centor Criteria PointsPresence of tonsillar exudates +1Tender anterior cervical adenopathy +1Fever by history +1Absence of cough +1Age <15 years +1Age >45 years − 1Centor
criteria4 points 2–3 points 0–1 pointNo further testsNo antibioticsRapid antigen
testTreat with
antibioticThroat
cultureTreat with
antibioticsNo further
testing