What Is This Patient’s Painful Rash?

AUTHORS:
Courtney Humphrey, MD • Judy Abu-Brown, MD

AFFILIATIONS:
St. Luke’s Family Medicine Residency, Bethlehem, Pennsylvania

CITATION:
Humphrey C, Abu-Brown J. What is this patient’s painful rash? Consultant. 2021;61(3):e12-e13. doi:10.25270/con.2020.06.00012

Received February 25, 2020. Accepted May 28, 2020. Published online June 10, 2020.

DISCLOSURES:
The authors report no relevant financial relationships.

CORRESPONDENCE:
Courtney Humphrey, MD, Clinical Faculty, St. Luke’s Family Medicine Residency Program, 2830 Easton Ave, Bethlehem, PA 18017 (courtney.humphrey@sluhn.org)

A 28-year-old woman presented with worsening pruritic rash for 3 weeks after having visited Jamaica. The rash was located on all 4 extremities, her lower back, and the inferior aspects of both buttocks. She had never had this rash before. She described the rash as burning, and the involved skin was tender to the touch. She denied any known new exposures and the use of any medications, other than a trial of over-the-counter topical hydrocortisone, which had provided no symptomatic relief. No other associated symptoms were present aside from a temperature of 37.8 °C.

Physical examination revealed a diffuse maculopapular rash on the upper and lower extremities (Figures 1 and 2) and symmetric erythematous patches on her lower back (Figure 3) and inferior aspect of her buttocks, sparing the midline. The patches were warm and tender to the touch.

Figure 1. A diffuse maculopapular rash on patient’s upper extremities.

Figure 2. A diffuse maculopapular rash on patient’s lower extremities.

Figure 3. Symmetric erythematous patches on the patient’s lower back and inferior aspect of her buttocks.

A punch biopsy was performed, the results of which revealed sparse superficial perivascular dermatitis with lymphocytic inflammatory infiltrates. Special stains for fungus (periodic acid–Schiff) and spirochetes (Warthin–Starry) were negative.