by James S. Walker, D.O. and David E. Hogan, D.O.
CHIEF COMPLAINT: Insect bite to left leg.
HISTORY OF PRESENT ILLNESS:
A 19-year-old male presents to the emergency department (ED) with the complaint of "something bit me" on the posterior aspect of his left calf 24 hours ago. A minor stinging or sticking sensation was felt after shortly after putting on his jeans which had been left on the bedroom floor overnight. He was not able to visualize or identify what caused this skin irritation. He remained asymptomatic until eight hours later when the involved area of skin began to itch as well as hurt. Worsening pain prompted this ED visit. He has no other complaints. He is healthy and takes no medications. Immunizations are current. He denies tobacco, alcohol and illicit drug use.
PHYSICAL EXAMINATION:
The patient is an alert male in mild discomfort. Vital signs are normal. The examination is normal except for the lesion of the left calf (figure 1). The lesion is 2 by 2 centimeters with 2 areas of ecchymosis with circumferential pallor.
INITIAL MANAGEMENT:
The patient was diagnosed as having an insect bite, was prescribed diphenhydramine (50mg) four times a day, and was instructed to return to the ED in four to five days if there was no improvement.
The patient course, diagnosis and discussion
From Academic Emergency Medicine 2(3):231, 234-237 1995 March
)window.location='http://www.embbs.com/img/bite.jpg'){kind=link}