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.
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 in 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 1). There were bilateral erythematous pustules on her hands. There were 2 crusted papules of the suprapubic area and 4 ulcerative lesions on her vulva (Figure 2).
Photograph of the facial lesions at the time of hospital admission.
Photograph of vulvar lesions at the time of hospital admission.
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