New Rash, Old Foe

      Sometimes, the sudden onset of a rash calls for a skin biopsy. Here, a 37-year-old African American man presented to the emergency department with the complaint of an itchy, generalized rash (Figure 1A,1B) that had come on suddenly the previous day. He also reported that sore throat, fever, and chills had begun 2 days prior to presentation, and he denied cough, headache, nausea, vomiting, or diarrhea. Although the patient was morbidly obese, he was otherwise healthy. He reported occasional use of ibuprofen for routine aches and pains over the past several years.
      Figure thumbnail gr1
      Figure 1(A) Diffuse, small (1-3 mm) pustular rash covered the patient’s abdominal wall. (B) A similar rash covered all 4 extremities as well. The right forearm is shown.
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