The patient is a 34-year-old woman who has just returned from the first camping trip of the year with her family. She relays that 2 days earlier, as she as she was setting up a tent, she “got stung” by something she didn’t see. As she struggled to free herself of the tent fabric, she was stung several more times on her hand and arm. She never saw the culprit. Not long after, she began vomiting and saw that her skin was erythematous.
View the photo and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.