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Clincal Challenge-2

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24 Jul 2020

A 60-year-old man with a history of gastroesophageal reflux disease (GERD) presents to the emergency department with 2 to 3 days of fever, non-bloody diarrhea, and a worsening non-pruritic rash. He recently traveled to Mexico on a cruise where he ate some local food and may have been bitten by mosquitos. He denies vomiting or abdominal pain, and a review of his other systems is otherwise normal.


Vitals signs are all normal except for an oral temperature of 101.8° F. His eyes are clear, and his oropharynx is moist without lesions. His heart and lungs are normal to auscultation, and his abdomen is benign without tenderness. He has an impressive rash that is most severe on his legs and is non-blanching (see image).


Complete blood count, Chem7, and liver function test are all normal. C-reactive protein and erythrocyte sedimentation rate (ESR) were both elevated at 82 and 61, respectively.

  1. What is the most likely cause of this rash?

  2. What additional testing might be useful?

Drop your answer, with justification, in comment.... Correct Answer will be posted on Monday.

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Dr. Ateendra Jha

Dr. Ateendra Jha is a data expert and a software engineer who works in the field of artificial intelligence, machine learning, and data science. He has a diverse and impressive background, having pursued a Doctor of Pharmacy, worked as a product manager, an assistant professor, a hospital administrator, and a researcher. He has also guided many students and projects in various domains of health and technology. He is currently a Consultant (Software Engineer Lead) at Capgemini, where he contributes to innovative solutions and groundbreaking developments in AI and data analysis. He is also a writer, speaker, editorial board member, and health expert who shares his knowledge and insights on various platforms. He has a website where you can learn more about him and his work.

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