What to do for rash and pimples spreading across the body?

Question

Hello doctor,

I am a 49-year-old female, who has so far consulted two infectious disease doctors, my ENT, my primary care doctor, and a dermatologist. I believe I have an undiagnosed parasitic infection. I have a primary immune deficiency, for which I receive IV Ig every three weeks, and I am in generally fair to poor health. I have a history of chronic osteomyelitis of skull bones and mastoiditis. The infection symptoms started approximately three months ago after a hospital stay, mostly bacterial or viral. I got a rash and pimples on the lips, which moved to around the mouth and looked like impetigo. I picked at it and pulled out the heads of the pimples with a tweezer. It created deep pitting sores (will send photos). It did not bleed, but my pores seem to be open.

Then it got painful when it settled into my left jaw, chin, left cheek, left ear, and it started breaking through my mastoidectomy scar. I think it was me touching the pimple and then touching my scar, which made it spread. And then it turned into cellulitis on my face; I had what could only be described as fluctuant carbuncles. It was horrible, and I also started to get spots rubbery hard skin where the scab should be. Now I am wondering if this is the parasite trying to wall itself off. Important to note here that I had two negative cultures within the first six weeks. Also important to note that the stuff coming from the wounds was not a typical pus, it was more of a gel-like substance. But because of my history, and because of the presentation of the wounds, I was put on IV antibiotics. I have been on Cefazolin, Rocephin, Invanz, oral Flagyl, and Keflex. Nothing was working, and it spread all over my body.

I went to a doctor and had him look at this weird crack on my foot that has been bugging me, and he said it is an athlete's foot. This is weird because the only place I take a shower or go barefoot is my shower. So I wondered if there was a fungal element to this, and I had some Fluconazole, so I took it and applied athlete's foot cream on my face, and it started to resolve. I have taken my second dose of Ivermectin, but my doctor is a huge skeptic, and I wondered if I could send you a picture of these disgusting things that are now coming out of my skin. The place where I think I have the largest concentration of these things is my empty left mastoid cavity. It is tough finding information that matches my symptoms online.

Answer 1

Hello,

Welcome to icliniq.com.

As per the images and culture report attached (attachment removed to protect patient identity), it is clear that it is primarily not an infectious condition. To add to this, antibiotics are therefore not helping you much. There is one entity known as dermatitis artefacta, in this, one tends to unknowingly poke or manipulate preexisting lesions over any part of the body. As you have also mentioned, you try to squeeze them to take out the material of it. Squeezing or poking leads to erosions of skin and damage the underlying layers of skin including the dermis. Once the dermis is compromised, scar formation occurs. Secondary bacterial infection emerges very commonly on eroded or damaged skin.

Another likely possibility is that because of the primary immunodeficiency that you have been suffering from, you tend to develop a bacterial infection known as impetigo. It is characterized by honeycomb crust deposits over the lesion. Due to repeated squeezing or weak immunity, it goes deeper and leads to scarring. I would advise you to start oral antibiotics by the latest culture report. In addition to this, it is most important to apply Mupirocin ointment inside both nostrils, twice daily for two weeks, it will help in treating the carrier state. You may discuss this with your treating doctor.

I hope it helps you.