Photo Quiz

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

Nguyet-Cam V. Lam, MD; Emelia Perez, MD

Am Fam Physician. 2018;97(2):129-134.

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.

(Enlarge Image)

Figure 1.

1 2 3

Next Section

Abstract and Introduction
Question
Discussion
References

SUMMARY TABLE
SUMMARY TABLE
Condition	Characteristics	Exposure/triggers
Contact dermatitis	Vesicles, edema, redness, pruritus	Delayed hypersensitivity reaction
Drug eruption	Diffuse maculopapular or papulosquamous rash or hives	Medications such as penicillin, carbamazepine (Tegretol), and allopurinol
Erythema multiforme	Target lesions; maculopapules with central clearing and a discrete ring of erythema	Cutaneous reaction to antigenic stimuli such as drugs or an infection; may be idiopathic
Erythema nodosum	Pink or dusty-red, firm nodules with blurred edges	Acute inflammatory and immunologic reaction of subcutaneous fat to drugs, infection, or inflammatory diseases
Sweet syndrome	Painful, erythematous papules, nodules, or plaques on the skin or mucosa	Accumulation of neutrophils in the dermis; triggers include infection, drugs, malignancy, inflammatory disorders, pregnancy, and vaccination