Wednesday, September 5, 2007
A 30 year old man comes into your clinic because of this rash shown above. He says that it began around his bellybutton and has spread to his back, his chest, and now his arms. He says, "The rash started a few days ago, but I haven't had any contact with anything new or different. I mean, last week, I got bit by that stupid Arizona coral snake again, but I took some micrurus antivenin. When I was bitten by it last year, I took the same antivenin, so I know I'm not allergic to either the snake or the meds."
On exam, you find no mucosal or pharyngeal lesions. The patient has a temperature of 39 C but he says his temperature has been fluctuating a lot. He also complains about painful knees, wrists, ankles, and shoulders. You notice no swelling in those joints. He says his muscles have been feeling weak. The rest of the exam is normal.
Challenge: What is the diagnosis?
1. How would you describe that skin lesion?
2. What is the joint complaint called?
3. What type of reaction is this? That is, what is the pathogenesis?
Image is in the public domain.