May 2017






HPI: 27 year old Indian male with no significant past medical history presents to the emergency department with complaints of nasal congestion, non-productive cough, runny nose, sore throat, and body aches for the past 5 days. He states, “I feel like my immune system is shutting down.” He also notes an itchy rash for the past 3 days that he feels is spreading over his body. He initially started azithromycin 4 days ago and was then seen in the emergency department two days ago and changed to oral prednisone and amoxicillin with no improvement. He recently returned from a trip to India. ROS is significant for a burning sensation in the eyes, subjective fever, and diffuse myalgia.


PMH/PSH: None per patient.

Social History: No tobacco, no alcohol use, denies illicit drug use.

Family History: No known family history, no family members with similar rash.

Allergies: No known drug allergies.

Medications: Started Azithromycin 4 days ago and was changed to Amoxicillin and prednisone 2 days ago. No prior medications.


Laboratory results:  CBC within normal limits, CMP notable for AST 65 and ALT 88, RPR nonreactive, Strep swab negative, Mono spot negative, Measles IgG serology negative, Measles IgM serology positive.


Physical Exam: Erythematous non-scaly macules and scattered papules coalescing into patches on face, neck, trunk (Fig. 1), and extremities including the palms. Numerous clustered approximately 1mm white macules on the bilateral buccal mucosa (Fig. 2). Bilateral conjunctival injection present.  


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