A 34-year-old Returning From Cambodia With Fevers and New-onset Rash

Abstract

Mrs L, a 34-year-old woman with a recent travel history to Cambodia, presented with fevers (up to 104°F), chills, and a new-onset rash. While on vacation with her husband, Mrs. L developed a 104°F temperature, malaise, and weakness 4 days into their trip. Two days later, she developed a pruritic, erythematous, blanchable rash on her arms along with moderate right flank pain. The following day the rash had extended to her entire body, except for the palms of her hands and the soles of her feet. At this point, she sought medical care and went to a Cambodian hospital where she was admitted. She denied having had any respiratory symptoms, nausea/vomiting, headaches, diarrhea, conjunctivitis, coryza, or cough. She had spent the first 2 days of their trip in rural areas near Koh Ker and the next 2 days at Angkor Wat. Both Mr. and Mrs. L had eaten grilled squid with a fresh vegetable salad. They both denied being bitten by mosquitoes or swimming in fresh or salt water. Mr. L remained asymptomatic. Mrs. L spent most of that day in the Cambodian hospital, but then left against medical advice to seek medical care in Utah, where she was also admitted. Roxanne Royce, MSN, ANP, is an adult nurse practitioner at Colorado Travel Health in Boulder, Colorado. She can be reached at .