Published on
A 42-year-old male presents to urgent care with complaints of cough, throat pain, and vomiting that developed earlier that morning. He returned from a family vacation to the US Virgin Islands 7 days ago and two days later, he began feeling ill with initial symptoms of high fever, myalgia, and severe headache. Over the past 3 days, he has noticed the development of a widespread rash on his trunk. The rash initially appears faint and asymptomatic but has become increasingly pronounced and intensely pruritic.
Physical examination reveals mild erythema of the posterior pharynx without tonsillar edema or exudates, a normal neurologic exam, clear lung sounds, a soft and non-tender abdomen, and widespread erythematous patches and papules on the abdomen, as shown in the photo above. A tourniquet test is positive.
View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.
