Case 34-2009 -- A 20-Year-Old Man with Sore Throat, Fever, and Rash

doi:10.1056/NEJMcpc0905543

Volume 361:1787-1796		October 29, 2009		Number 18

Case 34-2009 — A 20-Year-Old Man with Sore Throat, Fever, and Rash

Charles R. Taylor, M.D., Rajesh T. Gandhi, M.D., Jason Handwerker, M.D., and Lyn M. Duncan, M.D.

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Presentation of Case

Dr. Robert W. McGarrah (Medicine): A 20-year-old man was admittedto this hospital because of sore throat, fever, and a diffuserash.

The patient had been well until approximately 4 weeks earlier,when sore throat developed. On examination by his internist,vital signs were normal, the temperature was 36.8°C, andthere was pharyngeal erythema without cervical lymphadenopathy.A rapid streptococcal-antigen test was negative. The next day,he felt better.

One week before admission, sore throat and fever recurred, andthe patient returned to his internist the next day. The temperaturewas 37.1°C and the pulse 102 beats per minute; he . . . [Full Text of this Article]

Differential Diagnosis

Infectious Causes

Exogenous Causes

Inflammatory Causes

Lymphoproliferative Disorders

Lymphomatoid Papulosis (Macaulay's Disease)

Pityriasis Lichenoides et Varioliformis Acuta (Mucha–Habermann Disease)

Clinical Diagnosis

Dr. Charles R. Taylor's Diagnosis

Pathological Discussion

Anatomical Diagnosis

Source Information

From the Department of Dermatology (C.R.T.), the Division of Infectious Diseases (R.T.G.), and the Departments of Radiology (J.H.) and Pathology (L.M.D.), Massachusetts General Hospital; and the Departments of Dermatology (C.R.T.), Medicine (R.T.G.), Radiology (J.H.), and Pathology (L.M.D.), Harvard Medical School.