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Download the article PDF: Clinical Image Challenge December 2025
A 45‑year‑old male presents to urgent care with headache, malaise, and an arm lesion that appeared three days ago. He reports no recent travel but notes several mice in his New York City apartment. On examination he is febrile (39.4 °C / 101 °F) and dermatologic exam reveals an eschar lesion with surrounding erythema and adjacent erythematous papules on the arm. Numerous scattered papulovesicles are also present on the trunk and forearms. Laboratory studies show mild leukopenia and thrombocytopenia.
View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.
45-Year-Old Male With Arm Lesion, Headache, and Malaise
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