Background: Fixed drug eruptions (FDEs) are a form of delayed-type hypersensitivity mediated by CD8+ T cells triggered by offending agents resulting in recurrent lesions. Multifocal bullous subtypes are rarer but do exist and can mimic other blistering diseases posing a diagnostic challenge in the emergency department setting. Case Presentation: A 54-year-old Malay lady presented to the emergency department with a painful blistering rash over bilateral extensor forearm and elbow. They appeared as dusky, well-demarcated round plaques with central tense bullae. She had six to seven similar episodes over the past two years, recurring every three to four months with self-resolution each time. Skin biopsy demonstrated superficial perivascular dermatitis with pigmentary incontinence. Direct immunofluorescence and autoimmune serology with blistering disease BP 180 and BP 230 were negative. These findings support a diagnosis of probable multifocal bullous fixed drug eruption. The culprit agent was not identified, and the patient was advised for... Continue Reading

Objective: This study aimed to evaluate the pain management practices for oncology patients in the emergency department (ED), focusing on pain assessment, analgesic use, and treatment effectiveness.Methods: This retrospective cohort study was conducted at King Abdulaziz Medical City in Jeddah, Saudi Arabia, from January 2020 to December 2023. A total of 341 oncology patients who presented to the ED with pain were included. As pain scores for most patients were missing, observed values were retained, and a transparent, conservative approach was used to estimate missing scores to enable inferential analyses. The primary outcome was effective pain relief (≥2-point reduction, 0–10 scale).Results: The mean age was 54 years, and 47% of participants were male. Pre-treatment pain scores were documented in 18% of patients; reassessment after analgesia was recorded in 28%. The mean pain score decreased from 7.4 pre-treatment to 1.6 post-treatment (p < 0.001). Opioid use was associated with greater odds... Continue Reading