Photo Quiz

Rapidly Progressing Rash in an Adult

 


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Am Fam Physician. 2015 Sep 15;92(6):525-526.

A 40-year-old woman with no significant medical history presented with a nonpruritic rash that developed rapidly over three days and was progressively worsening. Three days before the rash appeared, she had a fever of 103°F (39.4°C), sore throat, and headache. Diphenhydramine (Benadryl) provided no relief. Ten days before her own symptoms developed, the patient's eight-year-old daughter had a fever, diarrhea, and a similar rash on her feet. The patient had not been exposed to any new medications, foods, or soaps and had not traveled recently.

On physical examination, the patient's temperature was 101°F (38.3°C). She had a diffuse erythematous papulovesicular rash on her distal upper and lower extremities, including her palms and soles (Figure 1). She had a similar rash on her face, predominantly around her lips (Figure 2), and an isolated macule on her soft palate. There was no rash on her trunk. The remainder of her examination was unremarkable.


Figure 1.


Figure 2.

Question

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Disseminated herpes simplex virus infection.

B. Hand-foot-and-mouth disease.

C. Secondary syphilis.

D. Varicella (chickenpox).

The authors thank Kathleen Slim, MA, for assistance with photography.

Address correspondence to Satyajeet Roy, MD, FACP, at roy-satyajeet@cooperhealth.edu. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. Hand-foot-and-mouth disease. Updated 2014. BMJ Best Practices. http://us.bestpractice.bmj.com/best-practice/monograph/685.html (subscription required). Accessed January 31, 2015....

2. Centers for Disease Control and Prevention. Hand, foot, and mouth disease (HFMD). Signs and symptoms. http://www.cdc.gov/hand-foot-mouth/about/signs-symptoms.html. Accessed June 4, 2014.

3. Enteroviruses. In: Cecil RL, Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, Pa.: Elsevier-Saunders; 2012:2140–2143.

4. Downing C, Ramirez-Fort MK, Doan HQ, et al. Coxsackievirus A6 associated hand, foot and mouth disease in adults: clinical presentation and review of the literature. J Clin Virol. 2014;60(4):381–386.

5. Romero JR, Modlin JF. Introduction to the human enterovirus and parechoviruses. In: Bennett JE, Dolin R, Blaser MJ, et al., eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pa.: Elsevier-Saunders; 2014.

This series is coordinated by John E. Delzell, Jr., MD, MSPH, Assistant Medical Editor.

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