Case description
A 51-year-old man with a past medical history of 16 pack years of
smoking presented to the emergency department with new onset severe
bilateral ankle pain. He reported a 10-day history of fatigue, fever
with a maximum temperature of 102.5 F, night sweats, and the development
of erythematous, painful papular rashes that started on his knees and
continued to spread all over the body. The patient also noted an episode
of chest pain and dry coughs but denied shortness of breath and
hemoptysis. Additionally, the patient reported a 24-lb weight loss over
several weeks due to loss of appetite. He denied a history of oral or
genital ulcers.
Occupational history revealed he worked on a city farm and had
previously worked as an environmental specialist in a sewage plant. The
patient denied a history of exposure to animal droppings, hazardous
materials, recent travel outside the state, or sick contacts.
On physical examination, the patient was afebrile, and his respiratory
system was unremarkable. Posterior cervical lymphadenopathies and
multiple painful, well-circumscribed, erythematous, edematous plaques
involving 10-12 % of his body surface area with sparing of the palms
and soles were noted (Fig 1.1-1.3). Mild swelling and pain with motion
of the bilateral ankles were observed.