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Picture of the Month Quiz

A previously healthy 19-year-old white woman was hospitalized with a 4-day history of a rash of unknown etiology. The rash began with an erythematous papule on her right cheek 4 days prior to admission that ulcerated and formed a black eschar. Three days prior to admission, she developed a similar lesion on her nose. One day prior to hospitalization, she noted multiple genital lesions. She was hospitalized for diagnostic evaluation after developing a temperature, measured orally, of 100.0°F and additional lesions on the dorsal aspect of both her hands. The lesions were mildly pruritic. Associated symptoms included a mild headache and a 1-day history of myalgias.

On admission she appeared healthy, with normal vital signs. She had an enlarged submandibular lymph node and inguinal lymphadenopathy. A dermatologic examination revealed an approximately 1-cm-diameter central eschar surrounded by a raised, cream-colored ring with an erythematous base extending approximately 3 cm around the lesions located on her nose and right cheek (Figure). There were bilateral erythematous pustules on her hands. There were 2 crusted papules of the suprapubic area and 4 ulcerative lesions on her vulva.

Image of rash of unknown etiology


What is your diagnosis?

For a complete discussion of this month's case, read next month's Picture of the Month—Quiz Case. For a complete discussion of last month's case, read this month's Picture of the Month—Quiz Case.