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 hands. The lesions were mildly pruritic. Associated symptoms included a mild headache and a 1-day history of myalgias.