Diffuse Centripetal Vesicular Rash

Extract

A 25-year-old white woman from Texas presented with a 5-day history of a progressive asynchronous rash with macules, papules, vesicles, pustules, and crusted lesions. The rash had a centripetal distribution, appearing initially on the extremities and spreading to back, torso, and face, but sparing palms, soles, genitalia, and mucous membranes. The rash was mildly pruritic and painful. The patient had a low-grade temperature but had no neurological, respiratory, or cardiac symptoms.

The patient had a history of primary varicella infection at 6 years of age. Five years before presentation, while pregnant with her first child, the patient had a right scapular zoster-like eruption. She had eczema, for which she occasionally used topical steroids; her eczema was well-controlled at the time of the eruption. She denied any recent travel, sick contacts, pets, or dietary changes.

At the time of hospital admission, her temperature was 38.3°C, her blood pressure was 120/70 mmHg, her pulse was 70 beats/min, and her respiratory rate 18 breaths/min. Except for the skin lesions (Figure 1), findings of a physical examination were unremarkable. The results of laboratory studies, including complete blood count, basic metabolic profile, and liver function tests, were all within normal limits. Tests to determine human immunodeficiency virus (HIV) serostatus, HIV viral load, and rapid plasma reagin titers all had negative results.