A 22-year-old woman presents with oral ulcers and a rash on her palms of 4 days’ duration. She does not take any prescribed or over-the-counter medications. Review of systems is noncontributory, and she denies fevers, chills, shortness of breath, cough, and genital lesions. Vital signs are normal, and physical examination reveals shallow erosions with hemorrhagic crusts on the lips and widespread targetoid macules with dusky centers on the palms (Figure). The remainder of the examination is unremarkable.
Ladizinski B, Lee KC. Oral Ulcers and Targetoid Lesions on the Palms. JAMA. 2014;311(11):1152-1153. doi:10.1001/jama.2013.286218