SAEM Clinical Image Series: Tea & Toast | A Case of an Abdominal Rash

By Jonathan Abraham, MD August 12, 2019 0 comments

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Chief complaint: Abdominal pain, nausea, and vomiting

History of present illness: A 46 year-old female with a past history of fibromyalgia, irritable bowel disease, and chronic abdominal pain presented to the emergency department with abdominal pain, nausea, and vomiting. She reported a one-year history of similar symptoms but states that her symptoms are worse today than usual, and not improved by her home hydrocodone, medical marijuana, or heating pad use – all of which she uses daily. She has not been able to tolerate oral intake today, vomiting up her breakfast of plain toast.

The patient was observed using her home heating pad in the emergency department.

Physical Exam

General Appearance: A chronically ill-appearing adult female who smelled of marijuana

Abdominal Exam: No focal tenderness and a non-pruritic reticulated rash

Laboratory Data

WBC: 10.6 × 10⁹/L

AST: 21 U/L

ALT: 19 U/L

Lipase: 26 U/L

Pregnancy: Negative

Urine analysis: Non-infected

Case Question: What is the explanation for the patient's abdominal rash?

Erythema ab igne

This rash is also known as “hot water bottle rash” or “toasted skin syndrome.” It results from chronic exposure to low levels of heat or infrared radiation. In our patient’s case, she experienced this rash stemming from her daily heating pad use (i.e. the “toast” in ‘Tea & Toast’, while the tea is old-school slang for the patient’s daily marijuana use).

Other cases have been seen in patients with occupational exposures (such as metal workers) or people who are using their laptop computers on their laps [1].

Case Question: What is the appropriate treatment for her rash?

The treatment involves removal of offending heat source, but may require additional medical treatment if cosmetic lesions persist.

Case Discussion

Take Home Points

Erythema ab igne is a benign but dramatic appearing rash that is seen with chronic exposure to a low-level heat source.
The mainstay of treatment involves removal of the heat source.
Most rashes will fade on their own over time, but may require referral to a dermatologist for cosmetic treatment, if symptoms persist.

Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2019 SAEM Annual Meeting | Copyrighted by SAEM 2019 – all rights reserved. View other cases from this series on ALiEM.