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A previously healthy 28-year-old man was admitted because of acute onset of shortness of breath after a 1-week history of fever, chills, cough, and body aches. The patient also reported a nonpruritic “rash” that began on his feet and legs, spread proximally, and coincided with the onset of respiratory difficulty. He denied past cutaneous eruptions and did not take any medications except for acetaminophen and ibuprofen starting 3 days before the onset of the exanthema.
On physical examination, he was found to be in respiratory distress and had coarse breath sounds and crackles on auscultation. Findings of the skin examination were significant for multiple erythematous blanching macules, 2 to 3 mm in diameter, on his feet, legs, arms, and the dorsal surfaces of his feet, some of which were coalescing (Figure 1). The skin lesions spared the axilla, groin, palms, soles, trunk, and face.
Vidal C, Kapelusznik L, Goldberg M, Halverstam C, Daefler S, Calfee D, Phelps RG. The Dermatologic Manifestation of Novel Influenza A(H1N1). Arch Dermatol. 2010;146(1):101-102. doi:10.1001/archdermatol.2009.344