Blog post- A different perspective on dx. of lice

  1. The tall, youthful seventy year old woman wore her strikingly white hair in a tight bun. She was dressed like a Donald Fagen song - in jeans and pearls ("Maxine", 1982).
    She had an intense burning, itching sensation on the left side of her neck and occiput. Looking closely at her neck and hairline, I saw a couple of small, red papules. A few of them looked like early blisters.
    I suspected herpes zoster and offered her a generic antiviral. The earlier you start it, the better your chances of avoiding long lasting pain afterward, I explained.
    A week later, there were some red blotches and several scratch marks. Her burning and itching were worse.
    I prescribed gabapentin and told her how to titrate herself up from 100 mg at bedtime to 300 mg three times a day.
    The following week she still had red blotches and scratch marks and felt no better. I frowned.
    She said "My granddaughters have head lice, so I asked my daughter to check me, but she couldn't find any. Would you check me, just to make sure?"
    I leaned close and removed my -11 diopter glasses. My focal point is about one finger length from my corneas.
    It took me a while, but I found half a dozen nits, enough to be sure she had the real thing.
    Didn't I feel a little sheepish. Seventy year old woman with burning and itching scalp? Must be zoster, right? Head lice is more of a pediatric problem, right?
    Wrong. I narrowed my differential diagnosis too quickly.
    And, I didn't take my glasses off the first time.

    acountrydoctorwrites | December 8, 2017 at 10:00 am | Categories: Progress Notes | URL: A Lousy Diagnostician | A Country Doctor Writes:

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  2. Visit Cattz profile page

    About Cattz

    Joined: Jan '16; Posts: 876; Likes: 2,667

    2 Comments

  3. by   OldDude
    K.I.S.S.
  4. by   ruby_jane
    Agreed, but who thinks about lice in Grandma? Although one might have expected after the first treatment didn't work that the doc would have done a more thorough check..

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