A 41-year-old African American woman presented with an 8-day history of fever, diarrhea, headache, and a nonproductive cough. Five days before admission, she noted an exanthem that had started on her face and had spread to involve her upper extremities and trunk.
A cutaneous examination revealed multiple minute vesiculopustules with surrounding dusky erythema distributed mainly on the face and upper trunk area (Figure 1), with scattered lesions on the upper extremities. Examination of the oral mucosa revealed soft palatal petechiae and an aphthouslike ulcer on the mucosa of the upper lip. Prominent anteroposterior cervical lymphadenopathy was palpable. The palms and soles were spared. A punch biopsy specimen was obtained (Figure 2).