Cases from the Osler Medical Service at Johns Hopkins University

Abstract

A 42-year-old woman presented to the emergency department at the Johns Hopkins Hospital complaining of a fever and a rash. The patient reported that 9 days before admission she noticed a painful rash on her left buttock. She was diagnosed with zoster and given a 10-day course of valacyclovir. However, on day 6 of therapy, the patient developed a new rash that started on her palms and soles, spreading up her arms and legs to her trunk, and moved to the mucous membranes in her mouth. The patient reported that the new rash began as erythematous circles with central vesicles, that it was itchy and painful, and that it seemed to be associated with fevers, chills, and rigors. Concurrently, she developed worsening of her migraine headaches and right eye redness and itching. The patient denied any nausea, vomiting, or abdominal symptoms, but had decreased oral intake due to painful oral lesions.