Case Study Week 2: Victoria Lewis (25-
Year Old Female with Skin Rashes)
Comprehensive Clinical Review |
Diagnosis, SOAP Note, and Question
Study Quiz with Rationales (2025/2026 )
,Case Overview and Clinical Presentation
Victoria Lewis is a 25-year-old female who presents with an acute onset rash. The
most common presenting scenarios across case versions include:
Chief Complaint
"I have a new rash that started a few days ago".
Key Historical Features
The presentation varies, but commonly reported elements include:
Scenario A Scenario B
Scenario C
Variable (Contact (Drug
(Pityriasis Rosea)
Dermatitis) Eruption)
3 days after
Onset 3-4 days ago starting 7 days to 2 weeks
antibiotics
New laundry Viral prodrome
Key Amoxicillin for
detergent, new (possible), no new
Exposures sinus infection
lotion, hiking exposures
Mildly pruritic,
Pruritic (itchy), Pruritic, possible
Symptoms possible anxiety
mild burning mild fatigue
about rash
Trunk with
Trunk, arms,
Arms, legs, "Christmas tree"
Distribution areas of clothing
spreading pattern along
contact
Langer's lines
, Scenario A Scenario B
Scenario C
Variable (Contact (Drug
(Pityriasis Rosea)
Dermatitis) Eruption)
Denies fever,
Systemic Denies fever, Denies systemic
chills, possible
Symptoms chills, malaise symptoms
mild fatigue
🔍 Differential Diagnosis and Final Diagnosis
The final diagnosis depends entirely on the historical and physical exam findings
in your specific case. Here is the clinical reasoning for the most common
possibilities:
Most Common Final Diagnoses
1. Allergic Contact Dermatitis (Most Frequently Reported)
• ICD-10 Code: L23.9 (Allergic contact dermatitis, unspecified cause)
• Clinical Reasoning: The rash appears hours to days after skin contact with
an allergen (new detergent, lotion, or plant during hiking). It is typically
localized to exposed areas, pruritic, and features erythematous macules,
papules, or vesicles. There is an absence of systemic symptoms.
2. Drug-Induced Maculopapular Eruption
• ICD-10 Code: L27.0 (Generalized skin eruption due to drugs and
medicaments)
• Clinical Reasoning: The rash develops days after initiating a new
medication (amoxicillin). It is often generalized, maculopapular, and
pruritic, with a temporal relationship to drug administration.
3. Pityriasis Rosea
• ICD-10 Code: L42 (Pityriasis rosea)
Year Old Female with Skin Rashes)
Comprehensive Clinical Review |
Diagnosis, SOAP Note, and Question
Study Quiz with Rationales (2025/2026 )
,Case Overview and Clinical Presentation
Victoria Lewis is a 25-year-old female who presents with an acute onset rash. The
most common presenting scenarios across case versions include:
Chief Complaint
"I have a new rash that started a few days ago".
Key Historical Features
The presentation varies, but commonly reported elements include:
Scenario A Scenario B
Scenario C
Variable (Contact (Drug
(Pityriasis Rosea)
Dermatitis) Eruption)
3 days after
Onset 3-4 days ago starting 7 days to 2 weeks
antibiotics
New laundry Viral prodrome
Key Amoxicillin for
detergent, new (possible), no new
Exposures sinus infection
lotion, hiking exposures
Mildly pruritic,
Pruritic (itchy), Pruritic, possible
Symptoms possible anxiety
mild burning mild fatigue
about rash
Trunk with
Trunk, arms,
Arms, legs, "Christmas tree"
Distribution areas of clothing
spreading pattern along
contact
Langer's lines
, Scenario A Scenario B
Scenario C
Variable (Contact (Drug
(Pityriasis Rosea)
Dermatitis) Eruption)
Denies fever,
Systemic Denies fever, Denies systemic
chills, possible
Symptoms chills, malaise symptoms
mild fatigue
🔍 Differential Diagnosis and Final Diagnosis
The final diagnosis depends entirely on the historical and physical exam findings
in your specific case. Here is the clinical reasoning for the most common
possibilities:
Most Common Final Diagnoses
1. Allergic Contact Dermatitis (Most Frequently Reported)
• ICD-10 Code: L23.9 (Allergic contact dermatitis, unspecified cause)
• Clinical Reasoning: The rash appears hours to days after skin contact with
an allergen (new detergent, lotion, or plant during hiking). It is typically
localized to exposed areas, pruritic, and features erythematous macules,
papules, or vesicles. There is an absence of systemic symptoms.
2. Drug-Induced Maculopapular Eruption
• ICD-10 Code: L27.0 (Generalized skin eruption due to drugs and
medicaments)
• Clinical Reasoning: The rash develops days after initiating a new
medication (amoxicillin). It is often generalized, maculopapular, and
pruritic, with a temporal relationship to drug administration.
3. Pityriasis Rosea
• ICD-10 Code: L42 (Pityriasis rosea)
