History: 54 y/o white male presents from an outside hospital with a one-week history of fever, weakness, and cough followed by a rash. The patient was initially treated with antibiotics for possible pneumonia, with no improvement in symptoms.
Physical Exam: Red, edematous papules with central crusting over the face, trunk and extremities. Erosions on the lower lip and hard palate.
Labs: WBC 24.7, Hgb 7.3, Hct 21.1, Platelets 19.
Peripheral blood smear showed atypical white cells but no evidence of acute leukemia or leukemic blasts.
Blood, sputum, and urine cultures were negative.
Serologies were negative for HIV, VZV, HSV, histoplasmosis, blastomyces, bartonella, legionella, Q-fever, rickettsia, ehrlichiosis
CXR showed right middle and upper lobe opacities.
Click here for the Diagnosis.
Click here for CME Credit