Case of the Week: Hunting for deer and a diagnosis

While hunting, an 18-year-old male developed an erythematous, pruritic rash that started on his scalp and descended downwards. He first noticed the rash when he was field-dressing a mule deer—a process which involves removing the internal organs to preserve the hunted game. He later had three subsequent episodes of the rash at home and at work. Strangely, the striking presentation didn’t appear when the patient was hunting other types of deer and generally disappeared 24 hours after being treated with glucocorticoids.

His family physician was puzzled by the presentation and shared the case on Figure 1. A dermatologist suggested,

“Acute…urticaria. It can be of alimentary origin, pharmacological, by contact, by infections and [and it can be brought on by] emotional [stress]…”.

A clinical associate proposed the illness may be vector-borne. He asked,

“Are mule deers known to carry ticks or any known diseases from insects?”

Although the patient’s diagnosis is still unknown, the differential diagnosis includes acute urticaria, a condition characterized by pruritic, erythematous plaques, which can occur with or without angioedema. The eruption may be triggered by infection or an allergic reaction. It can resolve spontaneously, with antihistamines, or with glucocorticoids, as was the case here.


See and discuss the full case on Figure 1.