A 32-year-old woman presents to the emergency department for a mildly itchy rash on her legs of 3 days’ duration as well as lower extremity joint pain and abdominal pain. She states that she has had a typical winter cold for approximately 1 week and has been taking over-the-counter cough medication for her symptoms. The patient thought the rash may be the result of an allergic reaction to the medication, but the eruption worsened after discontinuation. She denies fever, dyspnea, diarrhea, vomiting, or other symptoms.

Vital signs are normal. On physical exam, nasal congestion is noted, but her oropharynx is clear to inspection, and her lungs are clear to auscultation without rales or wheezes. The patient’s rash affects both legs but is worse on the right.

Differential diagnosis includes an allergic reaction and meningococcemia. Laboratory results are normal, including complete blood cell count, prothrombin time, partial thromboplastin time, complete metabolic panel, liver function tests, and lipase. Findings from chest radiography are normal.  

What does the case image show? What is the next best step in treatment?

Click to the next page for answers

This article originally appeared on Clinical Advisor