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February 2005

Erythematous Plaques With Fever and Leukocytosis—Quiz Case

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Arch Dermatol. 2005;141(2):263-268. doi:10.1001/archderm.141.2.263-a

A 36-year-old man presented with a 7-day history of fever, general malaise, chills, and rash. He was taking no medications. His temperature was 39°C. He had conjunctivitis and multiple, tender, raised, well-demarcated, erythematous, 2- to 15-cm plaques on his forehead and neck and the upper part of his trunk and arms (Figure 1 and Figure 2). Some plaques had central clearing and peripheral elevation. The findings of the patient’s physical examination were otherwise unremarkable. A complete blood cell count showed a white blood cell count of 12.1×103/μL (reference range [RR], 5.0-10.0×103/μL), with 75% segmented neutrophils (RR, 40%-60%), and a hemoglobin level of 11.2 g/dL (RR, 14.0-16.0 g/dL). The C-reactive protein level was elevated, and the Westergren erythrocyte sedimentation rate was 40 mm/h (RR, 118 mm/h). A skin biopsy specimen was obtained from a lesion on the trunk (Figure 3).

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