Abrupt Onset of a Tender Rash on the Upper and Lower Extremities

Abstract and Introduction

Introduction

A 54-year-old woman presented with painful lesions on her upper and lower extremities that developed a few weeks earlier. The rash did not improve after two courses of antibiotics. She had a fever and severe generalized pain. Her medical history was unremarkable.

Physical examination revealed an erythematous rash with vesicles and papules (Figure 1). Her temperature was 101°F (38°C). She was admitted for intravenous antibiotic treatment, pain control, and infectious disease consultation. Initial laboratory results showed anemia, thrombocytopenia, elevated erythrocyte sedimentation rate, and elevated C-reactive protein level.

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Figure 1.

Am Fam Physician. 2018;97(2):129-134. © 2018 American Academy of Family Physicians