Cases from the Osler Medical Service at Johns Hopkins University

Abstract

A 44-year-old white woman was admitted with a 3-week history of fever, chills, sore throat, and a rash. She had been in her usual state of health until 3 weeks prior to admission when she developed a sore throat, a fever of 101°F, and myalgias. She denied recent travel or tick bites. Her primary care physician diagnosed an upper respiratory infection and prescribed trimethoprim-sulfamethoxazole. Two weeks prior to admission, she developed multiple erythematous papular lesions beginning on her thighs bilaterally and spreading to her trunk, face, arms, and lower legs over the course of the next week. She eventually developed lesions on her hands and the soles of her feet. The lesions were neither painful nor itchy. She continued to have low-grade fevers and presented to the Johns Hopkins Hospital for further evaluation.