A Case of a Curious Skin Lesion

Abstract

Question: A 30-year-old previously healthy man presented as a transfer from an outside hospital for 2–3 weeks of bullous ankle rash and new migratory arthralgias, Three weeks before presentation, he developed severe nontraumatic left-side shoulder pain of unclear etiology. He denied any inciting triggers, though noted he had removed a tick of unknown duration from his leg a month earlier. There were no rashes noted at that time. His shoulder pain progressed, and he subsequently developed left ankle and back pain. Along with the progression of pain, he developed an erythematous raised rash above his left medial malleolus, which developed purple bullae (Figure A) and then ruptured into a large open wound with purulent discharge (Figure B). He developed another pustular lesion on the medial surface of his left thigh which increased in size before rupturing into a similar wound (Figure C). He developed associated fevers up to 104°F. He was subsequently admitted to the general medicine service.