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Case of the Month - November 2014

Dr J van Lochem. SASTM

A 46-year old man presented with a two day history of a rash. He felt unwell a day before the rash started and had a sore throat. On examination he was apyrexial. The vesicular rash was present on the dorsum and palmar aspects of the hands and the dorsum and plantar aspects of both feet. A mouth ulcer was noted, and an exanthem over his trunk (figure 1). His urine test was clear. There was no travel history. He is a smoker and was in a rehabilitation centre for alcoholism a year ago, having remained dry since then but had started using marihuana instead. He was in a rehabilitation centre again and was discharged three weeks prior to the consultation.

He was treated for discoid lupus in 2002, and had not had a recurrence. He was not taking any medication and is currently working in a glass factory. His girlfriend's son was diagnosed with hand foot and mouth disease the previous week, although his rash did not look similar.

Question 1: What investigations would you perform?

Continue to Answer 1