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Dr Uzair
Dr Uzair, Doctor
Category: Medical
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Experience:  MBBS, FCPS (R) General Surgery. Years of experience in Emergency Medicine.
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I'm seeking medical advice for my father who is 68 years

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I'm seeking medical advice for my father who is 68 years old. He has never been sick or on any medicines at all. In December 2012 he was spending his winter in Arizona, he started getting a skin irritation and then his head, ears, hands, etc all started swelling. He visited the Dr. in Arizona and they prescribed some meds and a diagnosis of Cellulitis. He took the meds but not long after finishing them everything started coming back, he went back to the Dr. in Arizona and they advised him to go back to Canada and be treated there. To this date not one Dr. in our town believes it is Cellulitis and I am becoming very frustrated. They have done all kinds of bloodwork and some skin biopsy and everything comes back fine. As long as he is on prednisone he seems to be fine but the minute he quits taking prednisone his skin becomes very red, starts to get very dry and falls off everywhere, his joints get very achy and sore, he gets the chills very bad to the point of shaking and is very fatigued. The only solution that they have come up with is to refer him to a Dermatologist. I feel that there must be some kind of internal infection but don't know who to look to. Do you have any advice?
Hi. Welcome to JustAnswer. I shall try my best to assist you while you are corresponding with me.

Cellulitis is usually reserved for local swellings however, in definition it does include diffuse inflammation of the skin and the subcutaneous tissues as well.
The usual cause of cellulitis is bacteria. Fever, redness, pain in the inflammed area and skin ulceration are characteristic signs of cellulitis.
Blood work shows an increase in the white blood cell count and the inflammatory markers like CRP and ESR.
I believe what your dad is suffering from is an allergic reaction especially because it is generalized and is effectively controlled by Prednisolone.
The best course of action will be do perform a blood culture test when he has the swelling and fever with chills again. Fever with chills and rigors occurs when bacteria are flowing through the blood stream and that is the best time to do a blood culture tests since in quiescent phases this test produces a false negative test.
A dermatologist referral is fine but I also think he should see an Allergist and Immunologist plus an internist and if the blood culture reveals something positive, an infectious disease specialist should also be consulted.
Other than that an Echocardiogram should be done to rule out Infective Endocarditis and Rheumatic Fever which should be kept higher up in the list of differentials.
Please do discuss the above diagnoses with your Doctor and get the required tests done as well to proceed in the right direction.
Your father should also try a second generation anti histamine like Loratidine twice daily to see if that controls the rash and the swellings.
Any allergens or irritants around him should be removed and he should carefully identify these irritants and remove them from his environment.
Hope this helps.
Please do leave a positive rating if satisfied. If you need more information or have more queries, reply back without rating.
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