Corona, Lime, Sun, Rash: A Case Report of Severe Phytophotodermatitis in an Active Duty Soldier

ABSTRACT Dermatological complaints constitute a large portion of patient visits to both emergency departments and military clinics. Proper assessment to separate the benign diagnoses from life-threatening may prove challenging based on seemingly non-specific history and physical examination. Similarly, reflexive specialty consultation may delay treatment and overload the health care system. Phytophotodermatitis is caused by contact with sensitizing agents, including lime juice, which triggers localized skin reactions when exposed to ultraviolet A light. The resulting progression of erythema, edema, pain, and non-pruritic skin lesions presents a unique pattern limited to the area of initial psoralen contact. This uniquely limited pattern coupled with specific historical context provides evidence for diagnosis. We highlight the case of a 24-year- old otherwise healthy female returning from a leisure trip to Mexico with progressive worsening of erythematous bullae limited to her hands and wrists bilaterally, ultimately attributed to phytophotodermatitis from lime wedge exposure in her alcoholic beverages, commonly referred to as “Mexican Beer Hand.” Despite the severity of her initial appearance, her symptoms resolved without complication from limited supportive care.