A 25-year-old complains of fever and myalgias for 5 days and now has developed a macular rash over his palms and soles with some petechial lesions. The patient recently returned from a summer camping trip in Tennessee. Which of the following is the most likely cause of the rash?
a/. Contact dermatitis
b/. Sexual exposure
c/. Tick exposure
d/. Contaminated water
e/. Undercooked pork
b/. Sexual exposure
c/. Tick exposure
d/. Contaminated water
e/. Undercooked pork
Answer
The answer is c
The rash described is most consistent with Rocky Mountain spotted fever, for which a tick is the intermediate vector. Secondary syphilis could present with a macular rash in the same distribution, but the associated symptoms would be atypical. Always think of these two diagnoses when a rash begins on the palms and soles. Contact dermatitis would not cause petechial lesions. The skin lesions in disseminated gonococcal infection can be distal, but are usually few in number and are pustular. Giardiasis does not cause a rash. Trichinosis, typically associated with periorbital edema and severe myalgias, can cause splinter hemorrhages and a maculopapular rash, but would rarely show the distal involvement seen in this patient.
Labels:
Dermatology
Thanks for reading, please follow me on Google Plus for more medical articles. Dermatology Question #2. Please share if helpful...!