Patient Case: Urticaria
A 32-year-old woman presents to the emergency department with a sudden onset of itchy, raised red welts on her arms, legs, and torso that appeared four hours ago. She describes the lesions as varying in size and shape, coming and going in different areas. She denies fever, joint pain, or mucosal involvement but reports mild lip swelling.
She recently ate seafood at a restaurant for the first time in months and noticed itching about an hour later. She denies new medications, insect bites, or recent illnesses. Her past medical history is unremarkable, and she has no known drug allergies.
On examination, she has multiple erythematous, edematous plaques (wheals) with central pallor, some coalescing into larger lesions. There is mild perioral swelling but no signs of respiratory distress or stridor.
A diagnosis of acute urticaria, likely triggered by seafood allergy, is made. The patient is treated with oral antihistamines, given a short course of corticosteroids, and advised to avoid seafood. She is also counseled on recognizing signs of anaphylaxis and prescribed an epinephrine auto-injector for emergency use.
- What is the most likely diagnosis for this patient’s condition?
a) Erythema multiforme
b) Contact dermatitis
c) Urticaria
d) Angioedema - What is the most likely trigger for this patient’s urticaria?
a) Viral infection
b) Seafood allergy
c) Sun exposure
d) Stress - Which of the following clinical features differentiates urticaria from other skin conditions?
a) Fixed, scaly plaques that last for weeks
b) Painful skin blisters with mucosal involvement
c) Raised, itchy wheals that change location over hours
d) Petechial, non-blanching rash - What is the most appropriate initial management for this patient?
a) Topical antifungals
b) Oral antihistamines and corticosteroids
c) Systemic antibiotics
d) Immediate skin biopsy
