LAUSR

Our patient was a 31-year-old woman with an acute painful erythematous rash affecting her palms, soles of her feet, groin and genital region. There was associated swelling with intense itch and burning discomfort. She developed fever, frontal headache, sore throat, arthralgia and malaise during the following 24 hours. On examination, there was striking symmetrical well-defined erythema and oedema affecting the palms and soles, extending to the dorsal aspects of the toes. The erythema also involved the groin, upper medial thighs, medial buttocks, vulva and mons pubis. The rash evolved to become purpuric within 24 hours (Figure 1). Blood tests demonstrated lymphopenia, and C-reactive protein and erythrocyte sedimentation rate were elevated. Renal and liver function were normal. Histological examination of a skin biopsy taken from her thigh showed dermal oedema associated with a chronic inflammatory cell infiltrate with eosinophils. Immunofluorescence studies were negative. Parvovirus B19 was subsequently detected on a throat swab by PCR. The rash resolved within a week, with the only sequelae being Beau's lines affecting all the nails. This article is protected by copyright. All rights reserved.