A 24-year-old man comes to the office due to a nonpruritic, painless rash over his upper and lower extremities. Vital signs are within normal limits. Skin examination shows scattered lesions, shown in the image below. He has no oral or ocular mucosal erosions.

Further elaboration of medical history in this patient is most likely to reveal which of the following?

Question

A 24-year-old man comes to the office due to a nonpruritic, painless rash over his upper and lower extremities. Vital signs are within normal limits. Skin examination shows scattered lesions, shown in the image below. He has no oral or ocular mucosal erosions.

Further elaboration of medical history in this patient is most likely to reveal which of the following?

Quizplus · Accepted Answer

This patient has target-shaped skin lesions consistent with erythema multiforme (EM), an immune-mediated disorder that is usually triggered by a bacterial or viral infection (especially herpes simplex virus [HSV]). The lesions typically consist of 3 distinct color zones: A dusky center (often with a small bulla or crust)A pale surrounding zoneAn erythematous peripheral border A dusky center (often with a small bulla or crust) A pale surrounding zone An erythematous peripheral border Lesions are most common on the extensor surfaces of the distal extremities but may involve other areas. Mucosal lesions are present in up to 70% of cases. Lesions typically last for 1-2 weeks before healing and may recur, particularly in HSV-associated cases. The diagnosis of EM is based on clinical features; skin biopsy can be helpful if the diagnosis is uncertain. Treatment is primarily symptomatic (eg, topical corticosteroids, oral antihistamines, anesthetic mouthwash). Although HSV infection is the most common cause of EM, antiviral therapy does not shorten disease duration. However, continuous prophylactic antiviral therapy is recommended for HSV-induced or idiopathic EM with frequent or severe recurrences. (Choice A) Disseminated gonococcal infection (following an initial genitourinary infection) can present as a triad of tenosynovitis, migratory polyarthralgias, and dermatitis. The associated skin lesions are typically isolated papules or pustules predominantly found on the hands and feet. (Choice B) Lyme disease, transmitted by Ixodes tick bites, typically begins with a flu-like illness associated with a localized erythematous rash with central clearing. In disseminated disease, multiple lesions may develop; however, compared with EM, the typical "bull's-eye" (erythema migrans) lesions are much larger, slowly expand over time, and are more likely to be found in the axillary or inguinal area. typical "bull's-eye" (erythema migrans) lesions (Choice D) Urticaria present as well-circumscribed, raised erythematous plaques that evolve over minutes to hours following exposure to an antigen (eg, foods, medications). These lesions are typically very pruritic and resolve within 24 hours. Educational objective: Erythema multiforme is an acute, often recurrent, mucocutaneous eruption that usually follows a bacterial or viral infection, especially herpes simplex virus. Target-shaped lesions are the characteristic finding, and treatment is primarily symptomatic. __________ References: Erythema multiforme: a review of epidemiology, pathogenesis, clinical features, and treatment. (http://www.ncbi.nlm.nih.gov/pubmed/24034067)

A 24-Year-Old Man Comes to the Office Due to a Nonpruritic