A 25-year-old Man with Acute Maculo-Papular Rash and Target Lesions

A 25-year-old student had an erythematous eruption on his face, trunk and upper extremity. Initial maculo-papules evolved to target lesions with a vesicular center surrounded by alternating pale and dark rings. The eruption appeared at the dorsum of the hand and progressed proximally, four days after a flu-like episode, without use of drugs or medicines for a minimum of six-months. The changes were restricted to the skin, painless and mildly itching. More conspicuous lesions appeared on his right scapula, left shoulder, and the dorsum of the left hand (Figure 1). Previously, he was in good health, without a history of allergy or skin or mucosal disturbances. He denied alcoholism, tobacco smoking, use of illicit drugs, and vaccination. His girl friend had fever, fatigue, pharyngitis and lymphadenopathy shortly before the onset of his actual disease. Physical examination revealed the aforementioned skin changes, in addition to discrete bilateral posterior cervical lymphadenopathy, and a moderate nontender liver and spleen enlargement. The patient was eutrophic and afebrile, with no ocular, oral, nasal, genital or anal lesions. In addition to routine laboratory tests, he underwent a skin biopsy aiming to clear the diagnosis. Blood determinations revealed leukocytosis, lymphocytosis and 12% reactive lymphocytes. Except for a transient elevation of the aminotransferase levels, biochemical data were normal. Hepatosplenomegaly and lymph node enlargement rapidly regressed to normal, as well as the lymphocyte count. The skin lesions improved gradually and healed in about two weeks.